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Introduction: Hypertension (HTN) is the third leading risk factor contributing to the disease burden in Southeast Asia. Understanding its underlying mechanism, such as endothelial dysfunction, is very important. Apelin is a recently discovered endogenous peptide hormone that, along with Nitric Oxide (NO), is implicated in endothelial dysfunction and the severity of HTN. This can significantly reduce renal function and lead to microalbuminuria/proteinuria in 5-15% of patients. Aim: To measure serum apelin and NO in patients with newly diagnosed primary HTN with or without microalbuminuria and to investigate the correlation of serum apelin with HTN in the same study population. Materials and Methods: This cross-sectional study was conducted from February 2019 to January 2021 in the Department of Biochemistry In collaboration with the Department of Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 180 participants were included in the present study. Among them, 90 were newly diagnosed hypertensive patients, and 90 were non hypertensive. The study comprised of 90 hypertensive patients, with 46 having microalbuminuria (Group-A), 44 without microalbuminuria (Group-B) and 90 normotensive controls (Group-C). All participants underwent evaluation of their biochemical profile which included Fasting Plasma Sugar (FBS), serum urea, creatinine, Total Cholesterol (TC), Triglyceride (TG), High-density Lipoprotein cholesterol (HDL-c), Low-density Lipoprotein cholesterol (LDL-c), Very Low-Density Lipoprotein (VLDL), serum apelin and NO levels, and urine albumin. The comparison between the three groups was done by using Analysis of Variance (ANOVA) test with post-hoc analysis. The Chi-square test was used to compare categorical variables. Results: The mean age of the participants was 50.48±9.73 years. study comprised of 90 hypertensive patients, with 46 having microalbuminuria, 44 without microalbuminuria, and 90 normotensive controls. The mean serum apelin levels were 394.45±84.2, 386.9±86.12, and 62.73±22.87 ng/L, respectively, among patients with microalbuminuria, without microalbuminuria, and normotensive patients. Similarly, the mean serum NO levels were 6.31±2.94, 8.32±2.63, and 20.15±4.37 μmol/L, respectively, among the three groups. The comparison of mean values indicated a significant (p

Introduction: Hypertension (HTN) is the third leading risk factor contributing to the disease burden in Southeast Asia. Understanding its underlying mechanism, such as endothelial dysfunction, is very important. Apelin is a recently discovered endogenous peptide hormone that, along with Nitric Oxide (NO), is implicated in endothelial dysfunction and the severity of HTN. This can significantly reduce renal function and lead to microalbuminuria/proteinuria in 5-15% of patients. Aim: To measure serum apelin and NO in patients with newly diagnosed primary HTN with or without microalbuminuria and to investigate the correlation of serum apelin with HTN in the same study population. Materials and Methods: This cross-sectional study was conducted from February 2019 to January 2021 in the Department of Biochemistry In collaboration with the Department of Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 180 participants were included in the present study. Among them, 90 were newly diagnosed hypertensive patients, and 90 were non hypertensive. The study comprised of 90 hypertensive patients, with 46 having microalbuminuria (Group-A), 44 without microalbuminuria (Group-B) and 90 normotensive controls (Group-C). All participants underwent evaluation of their biochemical profile which included Fasting Plasma Sugar (FBS), serum urea, creatinine, Total Cholesterol (TC), Triglyceride (TG), High-density Lipoprotein cholesterol (HDL-c), Low-density Lipoprotein cholesterol (LDL-c), Very Low-Density Lipoprotein (VLDL), serum apelin and NO levels, and urine albumin. The comparison between the three groups was done by using Analysis of Variance (ANOVA) test with post-hoc analysis. The Chi-square test was used to compare categorical variables. Results: The mean age of the participants was 50.48±9.73 years. study comprised of 90 hypertensive patients, with 46 having microalbuminuria, 44 without microalbuminuria, and 90 normotensive controls. The mean serum apelin levels were 394.45±84.2, 386.9±86.12, and 62.73±22.87 ng/L, respectively, among patients with microalbuminuria, without microalbuminuria, and normotensive patients. Similarly, the mean serum NO levels were 6.31±2.94, 8.32±2.63, and 20.15±4.37 µmol/L, respectively, among the three groups. The comparison of mean values indicated a significant (p<0.001) positive correlation between the level of serum apelin and HTN and its complications, such as microalbuminuria. Conclusion: The positive correlation between serum apelin levels and blood pressure underscores the potential role of apelin in hypertensive pathophysiology. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of age and parity with gestational hypertension. Study Design: Case-control study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital, Sibi Pakistan, from Oct 2020 to Sep 2021. Methodology: A total of two hundred and sixty-eight (n=268) patients (134 controls and 134 cases) were included in this study. Data about age, parity, economic status and education status was recorded. Two consecutive readings of blood pressure were recorded in siting position, 4 hours apart, and the second reading was entered on the proforma. Results: Mean age of the patients was 28.10±5.61 years and 28.99±6.29 years in cases and controls, respectively. Mean gestational age was 38.46±1.02 weeks in cases and 38.04±1.00 weeks in controls. In cases, primigravida were 88(65.7%) and multigravida were 46(34.3%) and in controls 58(43.3%) were primigravida and 46(56.7%) were multigravida. Odds ratio was 2.50(95% CI: 1.53-4.10), p value was <0.001. In cases, 111 women (82.8%) were from young age group and 23 women (17.2%) belonged to advanced age group. In controls 94 women (70.2%) were of young age group while 40 women (29.8%) belonged to advanced age group (p value was 0.013). Conclusion: Primigravidae and women of younger age seem to have association with pregnancy induced hypertension. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is a hypertensive condition that occurs during pregnancy and accounts for 2% to 8% of complications related to pregnancy globally. The diagnosis of preeclampsia is made when the blood pressure exceeds 140/90 mmHg after 20 weeks of pregnancy, occurring on two separate occasions with a minimum time gap of 4 hours, or exceeds 160/100 mmHg within a short period of time. Several biomarkers have been identified for prediction and diagnosis of preeclampsia. One of these biomarkers is Placental induced growth factor (PlGF), a factor that promotes angiogenesis, which belongs to the vascular endothelial growth factor family. Significantly reduced serum levels of placental growth factor (PIGF) have been observed in women diagnosed with preeclampsia compared to normotensive pregnancies. This study was designed to answer the question whether the measurement of PIGF at third trimester might be a predictive factor for the appearance of preeclampsia. Method: A comparative study was made on 40 women with PE and 40 age-gestational-age matched women without preeclampsia, as case and control, respectively. Levels of serum PIGF were measured, compared and its role in prediction of preeclampsia was studied. Results: The mean serum level of PIGF in cases was significantly lower (78.54±152.63pg/ml) than mean serum PIGF level of controls (553.73±263.27 pg./ml). When ROC analysis was done, PIGF =121.9pg/ml was found giving highest Youden index with sensitivity of 97.50%(95%CI-86.8 - 99.9), specificity of 100% (95%CI-91.2-100) and AUC of 0.97 (95% CI =0.91-0.99). Conclusion: Along with the hallmark symptoms of preeclampsia like high blood pressure and proteinuria, measurement of PIGF levels in late pregnant stage may be helpful in prediction of preeclampsia before actual onset of clinical symptoms which further assist in better diagnosis and management of disease. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy involves a number of endocrine interactions. In our study to observe the possibility of physiological changes of IOP which could be a predisposing factor or development, early detection, changes in IOP during pregnancy and also in management of glaucoma during pregnancy. Objective: To determine the intraocular pressure between normotensive and preeclampsia women in peripartum period. Methodology: The present case control study was carried out at NMCH Raichur involving total 40 pregnant women (20 normotensive s and 20 preeclamptic) in peripartum period. Results: Mean prepartum IOP in right eye of the normotensive and preeclamptic patients was 15.38±1.02 and 18.44±1.42 (p<0.05). Mean prepartum IOP in left eye of the normotensive and preeclamptic patients was 15.82±1.04 and 19.42±1.88 (p<0.05). Mean postpartum IOP in right eye of the normotensive and preeclamptic patients was 15.48±1.04 and 20.52±1.92 (p<0.05). Mean postpartum IOP in right eye of the normotensive and preeclamptic patients was 16.02±1.14 and 20.34±1.78 (p<0.05). Conclusion: Compared with normotensive women, preeclamptic women have significantly increased intraocular pressure in the peripartum period. [ABSTRACT FROM AUTHOR]

Introduction: Foetal growth restriction (FGR), is a condition that occurs due to various reasons. It is an important cause of foetal and neonatal morbidity and mortality. It has been defined as a rate of foetal growth that is less than the growth potential of that specific infantor as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. It has been found to be associated with a variety of adverse perinatal outcomes. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemiaetc. The likely long-term complications that are prone to develop when FGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps etc. Methods: This cross-sectional study included all growth restricted babies born in the department of Obstetrics and Gynecology at Government Medical College, IMCH Kozhikodeduring the study period and their mothers. Multiple pregnancy with growth restriction were excluded from the study. Babies born outside IMCH but being referred to IMCH were also excluded. Socio -demographic and fetomaternal characteristics were collected after getting consent. Maternal data regarding socio-demographic variables including age, domicile (rural/urban), socio-economic status, data regarding gestational age, nature of ANC, past obstetric history including parity. Results: Perinatal mortality rate was 64.2/1000 in growth restricted babies born to normotensive mother group. The stillbirth rate was 36.6/1000 in growth restricted babies born to normotensive mother group. Fetal growthrestriction occurred more in rural womencompared to urban women. Women below poverty line had more fetal growth restriction compared to the women above poverty line and the difference was statistically significant. Early neonatal mortality rate was 28/1000 live IUGR babies in normotensive group. Conclusion: Mothers belonging to low socio-economic status have high risk of delivering babies with growth restriction. This is because of inadequate dietary intake, increased physical activity, passive smoking, increased rate of infections and low educational levels leading to decreased awareness regarding health care facilities. [ABSTRACT FROM AUTHOR]

Objective: We defined reference ranges for maternal cardiac output, systemic vascular resistance, and stroke volume measured in the third trimester of pregnancy using the Ultrasound Cardiac Output Monitor 1A. Design: Based on data from the prospective PEACH (PreEclampsia, Angiogenesis, Cardiac dysfunction and Hypertension) cohort study. Setting: Rigshospitalet and Hvidovre Hospital, Denmark. Sample: Normotensive pregnant women aged 18–45 years with singleton pregnancies, enrolled in the PEACH study in 2016–2018. Methods: We modelled cardiac output, systemic vascular resistance and stroke volume as a function of gestational age using multilevel linear models with fractional polynomials. Main Outcome Measures: Unconditional and conditional reference ranges for cardiovascular parameters measured in gestational weeks 28–40. Results: Our study cohort included 405 healthy pregnant women who contributed 1210 cardiovascular function measurements for analysis. Maximum cardiac output and stroke volume values were measured in gestational weeks 30–32 and decreased over the third trimester, whereas systemic vascular resistance increased during the same period. We created reference ranges for eight combinations of maternal height, age and parity. We also created a simple calculator to allow for implementation of the reference ranges in clinical practice. Conclusions: Our reference ranges allow the use of a bedside ultrasound device to non‐invasively assess cardiac function in pregnancy and identify women at risk of complications. The unconditional ranges allow clinicians to evaluate isolated measurements and identify women needing follow‐up. The conditional ranges incorporate information from previous measurements and improve monitoring over time. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy constitute one of the members of deadly triad of maternal death - along with hemorrhage and infection. It is postulated that the alteration of lipid metabolism may play a key role in the development of symptoms of PE and eclampsia. Materials and methods: It is a prospective case-control study. 50 normotensive pregnant women were selected as controls and 50 pregnant women with hypertensive disorders of pregnancy were selected as cases as per inclusion and exclusion criteria. A 5ml of fasting venous blood Samples were collected and lipid profile was done. Objective: To evaluate the association between serum lipid profile of women with hypertensive disorder of pregnancy and normotensive pregnancy. Results: There was significant rise in the values of Serum Triglycerides(TG), Low density Lipoprotein-C(LDL-C), Very Low Density Lipoprotein-C(VLDL-C) in the hypertensive disorder of pregnancy group compared to normotensive group. Conclusion: Pregnant women with hypertensive disorder of pregnancy have deranged serum lipid profile when compared to normotensive pregnant women. Dyslipidaemia play certain role in the pathogenesis of hypertensive disorder of pregnancy. Lipid profile can be used as a tool for the detection and management of Hypertensive disorder of pregnancy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hypertension is a major public health problem globally. Hypertension and dyslipidemia, coexisting in 15-31% are the major risk factors for coronary heart disease. Evaluation of Lipid profile among hypertensive patients is extremely important to detect and prevent complication associated with coexisting hypertension and dyslipidemia. MATERIAL & METHODS: Present study was a hospital based observational study done at Bidar Medical College Hospital where patients coming to the Out Patient Department were selected. Total duration of the study was for 6 months. Sample size was 80; out of which 40 hypertensive patients were taken and 40 as controls. A pre designed proforma was used to get the demographic clinical data and examination RESULTS: About three fourth were smokers and half the proportion alcoholics. 60% of hypertensive's had sedentary lifestyle. More than one thirds of the hypertensive's (37.5%) were obese. Mean total cholesterols, triglycerides and low density lipoprotein values were significantly higher in hypertensive compared to normotensive group and it was highly significant statistically (p<0.001). High density lipoproteins were lower in hypertensive group which is again statistically significant. CONCLUSIONS: it is imperative to evaluate the lipid profile frequently among the hypertensives so that any abnormality in it can be identified and treated at an early stage. Adequate counseling, dietary modifications and adherence to medications are required specifically for those hypertensive's who already been detected to have lipid abnormalities. [ABSTRACT FROM AUTHOR]

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110–115/70–75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of −1.37/−1.63 mm Hg and −2.79/−1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of −1.76 mm Hg and −2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population. [ABSTRACT FROM AUTHOR]

Background: Pheochromocytomas (PCCs) are catecholamine-producing neuroendocrine tumors that originate from the adrenal medulla. Their clinical presentations most commonly include hypertension, headache, palpitations, and sweating; however, PCCs are sometimes normotensive and clinically silent. Case Presentation: A female patient with abdominal pain as well as persistent and crushing left flank pain for the past six months was examined. The imaging studies revealed a mass in the upper pole of the left kidney indicative of a potential adrenal gland tumor; however, she had normal blood pressure (BP). Histopathologic examination of the mass from exploratory laparotomy showed that it was a PCC. Findings from sonography and computed tomography (CT) scan of the left adrenal tumor, along with elevated urinary normetanephrine level and positive iodine-123 metaiodobenzylguanidine (MIBG) scan led to preoperative diagnosis of PCC in our case. Conclusion: This study highlighted the importance of imaging and biochemical testing in diagnosing PCCs in patients with adrenal incidentalomas (AIs), even though they were normotensive and entirely asymptomatic.

Abstract Background Crescentic immunoglobulin A (IgA) nephropathy, defined as > 50% of the glomeruli with crescents, often has a poor renal prognosis. Because of the high prevalence of pre-eclampsia in the second trimester of pregnancy, we often fail to investigate the new onset of glomerulonephritis and the aggravation of subclinical nephropathies. We report a case of nephrotic syndrome suggestive of crescentic IgA nephropathy possibly triggered by pregnancy. Case presentation A 33-year-old multipara was referred for persistent proteinuria, hematuria, and hypoalbuminemia two months postpartum. The patient was diagnosed with proteinuria for the first time at 36 weeks of gestation. The patient was normotensive during pregnancy. Renal biopsy revealed crescentic IgA nephropathy, with cellular crescents in 80% of the glomeruli and no global sclerosis. After treatment with pulse steroids followed by high-dose oral glucocorticoids and tonsillectomy, a gradual improvement was seen in proteinuria, hematuria, and hypoalbuminemia. Conclusion Although the precise mechanism remains unclear, pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy.

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect up to 10% of pregnancies worldwide, despite improvements in maternal and neonatal care. HDP and its sequelae are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim: To study the efficacy of mid-second trimester serum b-hCG levels in the prediction of HDP. Materials and Methods: This was a longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at Shri BM Patil Medical College Hospital and Research Centre , Vijayapura, Karnataka, India, between December 2020 and June 2022. All women with gestational age between 16-20 weeks were screened, and 163 pregnant women were enrolled in the study. Serum β-hCG levels were measured at enrollment, and values were followed-up until delivery. The development of HDP was evaluated using statistical analysis, including Chi-square, Independent t-test, Receiver Operating Curve/Area under the ROC Curve (ROC/AUC), sensitivity, and specificity. A p-value of

Objectives: Hypertensive hemorrhage is a leading cause of intracerebral haemorrhage (ICH), although some of these patients may not present with high blood pressure (BP) at the time of ICH. Materials and Methods: This retrospective study included patients with history of hypertension presenting with ICH. Patients with systolic BP recording of more than 140 mmHg were included in hypertension group (group I). Patients whose BP rose to hypertension range after fluid correction were included in group II and patients with BP <140 mmHg on consecutive 1-week BP recordings were included in group III. Clinical features including volume of ICH of all the three groups were noted. Outcome in the form of mortality was analyzed. Chi-square test was used for categorical variables and independent t-test for continuous variables. P < 0.05 was considered significant. Results: Ninety-two ICH patients with history of hypertension were included in the study. Of them, 20 patients (22%) presented with BP <140 mmHg systolic at the time of ICH. After fluid correction, it rose to hypertensive range in 9 (10%) but remained normal in 11 patients (12%) during consecutive recordings for 1-week post-admission. On comparing normotensive and hypertensive groups, significant difference was seen in survival and volume of ICH. Conclusion: There is a subset of hypertensive patients who may present with normal BP recording during acute ICH. The BP rises subsequently with the correction of hypovolemia in some. The volume of hemorrhage in normotensives is relatively small but whether this translates into better prognosis needs further studies. [ABSTRACT FROM AUTHOR]

Context: Intraoperative hemodynamic instability (HI) deteriorates surgical outcomes of patients with normotensive pheochromocytoma (NP). Objective: To characterize the hemodynamics of NP and develop and externally validate a prediction model for intraoperative HI. Methods: Data on 117 patients with NP (derivation cohort) and 40 patients with normotensive adrenal myelolipoma (NAM) who underwent laparoscopic adrenalectomy from January 2011 to November 2021 were retrospectively collected. Data on 22 patients with NP (independent validation cohort) were collected from another hospital during the same period. The hemodynamic characteristics of patients with NP and NAM were compared. Machine learning models were used to identify risk factors associated with HI. The final model was visualized via a nomogram. Results: Forty-eight (41%) out of 117 patients experienced HI, which was significantly more than that for NAM. A multivariate logistic regression including age, tumor size, fasting plasma glucose, and preoperative systolic blood pressure showed good discrimination measured by area under curve (0.8286; 95% CI 0.6875-0.9696 and 0.7667; 95% CI 0.5386-0.9947) for predicting HI in internal and independent validation cohorts, respectively. The sensitivities and positive predictive values were 0.6667 and 0.7692 for the internal and 0.9167 and 0.6111 for the independent validations, respectively. The final model was visualized via a nomogram and yielded net benefits across a wide range of risk thresholds in decision curve analysis. Conclusion: Patients with NP experienced HI during laparoscopic adrenalectomy. The nomogram can be used for individualized prediction of intraoperative HI in patients with NP. [ABSTRACT FROM AUTHOR]

Abstract Background Preeclampsia affects the health of the mother and the fetus during pregnancy and childbirth. To date, little is known about the impact of preeclampsia on postpartum health-related to quality of life (HRQoL) in the Sidama region of southern Ethiopia. This study aimed to measure the HRQoL and its contributing factors among postpartum women with preeclampsia in the Sidama region. Methods A prospective cohort study was conducted by enrolling pregnant women at ≥20 weeks of gestation up until the 37th week of gestation. We then followed them until 12 weeks after delivery. A locally validated, World Health Organization Quality-of-Life-BREF (WHOQOL-BREF) tool was used to assess participants’ HRQoL at two time points; the 6th and 12th weeks postpartum. Assessment of HRQoL of participants was based on total scores on the WHOQoL-BREF. Higher scores on the WHOQoL-BREF reflected a higher HRQoL. Multiple linear regression analyses were performed to evaluate the contributing factors to HRQoL. The level of significance was determined at a p-value of

Several observational studies have shown inconclusive findings on the association between selenium levels and preeclampsia. This systematic review and meta-analysis was conducted to clarify the association between selenium levels and preeclampsia. The databases PubMed, Google Scholar, ScienceDirect, and the Cochrane Library were searched for studies which investigated selenium levels with preeclampsia and which were published up to April 2022. The overall standardized mean differences (SMD) of selenium levels between cases and controls were measured. Sensitivity analysis, reporting bias, subgroup analysis, and meta-regression were performed for the estimate. The meta-analysis was calculated using the "meta" package in the open-source software R. A total of 26 studies with 1855 preeclampsia cases compared with 3728 healthy pregnant controls were included. The level of selenium was significantly lower in cases of preeclampsia compared with the controls [SMD = − 0.85; 95% confidence interval (CI): (− 1.46, − 0.25); P = < 0.01). As there was significant heterogeneity [I2 = 96%, Cochran's Q = 620.47; P = < 0.01], the random effects model was used. A stratified meta-analysis revealed that selenium levels were significantly lower in the cases compared with the controls among pregnant women from the African continent [SMD = − 1.15 (− 1.65, − 0.65); P = < 0.01]. Likewise, the same pattern was observed among women from middle- and low-income countries [SMD = − 1.32 (− 2.22, − 0.42); P = < 0.01]. None of the investigated factors (Modified Newcastle–Ottawa Scale quality score, year of publication, and sample size) showed significant association with the selenium SMD. The level of certainty of this evidence is "low certainty," as calculated by the GRADEpro GDT online tool. This meta-analysis with low level of evidence certainty revealed that low selenium level is associated significantly with preeclampsia. This pattern is also observed in women from the African continent and women from low- or middle-income countries. Further studies with different prospective designs and detailed patient characteristics are needed to consolidate this evidence. [ABSTRACT FROM AUTHOR]

Patients with acute pulmonary embolism (PE) and hypotension (high-risk PE) have high mortality. Cardiogenic shock can also occur in nonhypotensive or normotensive patients (intermediate-risk PE) but is less well characterized. The authors sought to evaluate the prevalence and predictors of normotensive shock in intermediate-risk PE. Intermediate-risk PE patients in the FLASH (FlowTriever All-Comer Registry for Patient Safety and Hemodynamics) registry undergoing mechanical thrombectomy with the FlowTriever System (Inari Medical) were included. The prevalence of normotensive shock (systolic blood pressure ≥90 mm Hg but cardiac index ≤2.2 L/min/m2) was assessed. A composite shock score consisting of markers of right ventricular function and ischemia (elevated troponin, elevated B-type natriuretic peptide, moderately/severely reduced right ventricular function), central thrombus burden (saddle PE), potential additional embolization (concomitant deep vein thrombosis), and cardiovascular compensation (tachycardia) was prespecified and assessed for its ability to identify normotensive shock patients. Over one-third of intermediate-risk PE patients in FLASH (131/384, 34.1%) were in normotensive shock. The normotensive shock prevalence was 0% in patients with a composite shock score of 0 and 58.3% in those with a score of 6 (highest score). A score of 6 was a significant predictor of normotensive shock (odds ratio: 5.84; 95% CI: 2.00-17.04). Patients showed significant on-table improvements in hemodynamics post-thrombectomy, including normalization of the cardiac index in 30.5% of normotensive shock patients. Right ventricular size, function, dyspnea, and quality of life significantly improved at the 30-day follow-up. Although hemodynamically stable, over one-third of intermediate-risk FLASH patients were in normotensive shock with a depressed cardiac index. A composite shock score effectively further risk stratified these patients. Mechanical thrombectomy improved hemodynamics and functional outcomes at the 30-day follow-up. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Crescentic immunoglobulin A (IgA) nephropathy, defined as > 50% of the glomeruli with crescents, often has a poor renal prognosis. Because of the high prevalence of pre-eclampsia in the second trimester of pregnancy, we often fail to investigate the new onset of glomerulonephritis and the aggravation of subclinical nephropathies. We report a case of nephrotic syndrome suggestive of crescentic IgA nephropathy possibly triggered by pregnancy. Case presentation: A 33-year-old multipara was referred for persistent proteinuria, hematuria, and hypoalbuminemia two months postpartum. The patient was diagnosed with proteinuria for the first time at 36 weeks of gestation. The patient was normotensive during pregnancy. Renal biopsy revealed crescentic IgA nephropathy, with cellular crescents in 80% of the glomeruli and no global sclerosis. After treatment with pulse steroids followed by high-dose oral glucocorticoids and tonsillectomy, a gradual improvement was seen in proteinuria, hematuria, and hypoalbuminemia. Conclusion: Although the precise mechanism remains unclear, pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy. [ABSTRACT FROM AUTHOR]

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of prospective risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. We try to establish the correlation between the fatty liver with diastolic dysfunction in normotensive young patients under 40 years of age. Method: This cross-sectional analytical study was conducted between April 2021 and March 2022 in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa. It included 214 normotensive cases under 40 years with fatty liver. Patient information, clinical examination, and various tests were conducted to assess diastolic dysfunction. The collected data was compared with previous studies for analysis. Results: Out of 214 cases 105 (49%) were male and 109 were female (51%). Mean age of the patients was 27.84 ± 8.27 years. Out of 214 patient's normal diastolic dysfunction found in 167 (78.04%) cases followed by the 26 (12.15%) cases had grade-1, 15 (7.0%) cases had grade 2 and 06 (2.81%) patients had grade 3 diastolic dysfunction. Among all cases 180 (84.11%) of the patients had grade 1 fatty liver out of which 156 (86.66%) had no diastolic dysfunction, while the 17 (9.44%) cases had grade-1, 6 (3.33%) had grade 2, and 1 (0.55%) patient had grade 3 diastolic dysfunction. 29 (13.55%) cases were found to have grade 2 fatty liver out of which 6 (20.68%) had no diastolic dysfunction, while the 9 (31.03%) cases had grade-1, 9 (31.03%) had grade 2, and 5 (17.25%) patients had grade 3 diastolic dysfunction. 5 (2.33%) cases found to have grade 3 fatty liver all 5 (2.33%) were found to have no diastolic dysfunction. Conclusion: The prevalence of diastolic abnormalities in adults under 40 years with fatty liver was 21.9%, indicating a significant correlation. Clinicians should consider cardiovascular risks and undertake early risk factor modification. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is unknown whether a session of isometric handgrip (IHG) exercise can influence the blood pressure of hypertensive and normotensive individuals. OBJECTIVE: To compare post exercise hypotension among groups with different resting blood pressure (BP) levels. METHODS: 56 Malay male volunteers (12 normotensive, 14 pre-hypertensive, 19 hypertensive stage 1, and 11 hypertensive stage 2) completed four sets of 2-minute isometric handgrip exercises at 30% of their maximum handgrip contraction with a one-minute break between the sets. Systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), mean arterial pressure (MAP), resting heart rate (RHR), and handgrip strength (HGS) were measured before and after an hour of IHG exercise. A paired sample t -test, one-way ANOVA, and two-way repeated measure ANCOVA were used to examine the data. RESULTS: All parameters, except RHR and PP, were significantly changed following the exercise across the BP groups. The SBP, MAP, and HGS were greatly reduced among hypertensive stage 1 (SBP = - 6.3 ± 0.6 mmHg; MAP = - 4.8 ± 1.1 mmHg; HGS = - 6.8 ± - 0.4 mmHg) compared to other groups. Meanwhile, the most DBP was reduced among hypertensive stage 2 (mean = - 5.2 ± 0.6 mmHg). CONCLUSIONS: The current study discovered a significant reduction in BP among hypertensive stage 1 and 2 individuals after a session of IHG exercise. [ABSTRACT FROM AUTHOR]

Background: One of the primary risk factors for the beginning and development of chronic problems in type 2 diabetes mellitus is hypertension (DM). Aim and objectives: The aim of this study was early detection of BP abnormalities in people with type 2 diabetes mellitus over the course of 24 hours. Subjects and methods: The present study was carried out on 135 patients who presented to Cardiology Department at Zagazig University Hospitals and Cardiology Department at Matrtouh Cardiac Center in the duration between Janurary 2021 and Augest 2022. The patients were classified into three groups according to blood pressure dipping. Group 1 (Non-dippers): (n= 65), group 2 (dippers) included 53 cases and group 3 reversed dippers (n= 17). Results: Significant positive correlation was detected between ratio of BP dipping and height (r=0.209, p-value =0.015) as well as night BP (r=0.287, p-value =0.001) while there was significant negative correlation between ratio of BP dipping and TG (r=-0.217, p-value =0.011) as well as day BP (r=-0.363, p-value <0.001). Conclusion: Insightful information is provided by the study on the prevalence of aberrant ABP patterns and the limits of office blood pressure readings for either diagnosing hypertension or evaluating blood pressure control in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Introduction: To address the causes of maternal mortality and morbidity, reproductive health and related disabilities is a motto of World Health Organisation (WHO). Gestational hypertension constitutes as one of the main cause for maternal morbidity and mortality. Aetiology of gestational hypertension- remains a mystery. Mitochondrial dysfunction, particularly in trophoblastic cells, could play an important role in causing gestational hypertension and is postulated to be associated with oxidative stress, impaired differentiation and invasion of trophoblastic tissue. Alterations in peripheral blood mitochondrial Deoxyribonucleic Acid (DNA) copy numbers have been thought as a possible biomarker for mitochondrial dysfunction in disorders induced by oxidative stress. Aim: To estimate, evaluate and compare the mitochondrial copy numbers between placenta of severe gestational hypertensive pregnancies and normotensive pregnancies. Materials and Methods: A cross-sectional study was conducted at Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India, with 25 clinically proven cases of severe gestational hypertensive pregnancies and 25 normotensive pregnancies, for a period of one year (August 2020 to July 2021). The placenta were collected from the Department of Obstetrics, in containers within two hours of delivery and frozen in liquid nitrogen. Relative quantitative analysis of placental mitochondrial DNA (mtDNA), were done by calculating the copy number value by comparing the levels of two nuclear genes viz., BECN1 and NEB to two mitochondrial genes viz., ND1 and ND6 by using real time quantitative Polymerase Chain Reaction (PCR). Results: The placental mitochondrial DNA copy number was higher in severe gestational hypertensive patients than in normotensive pregnancies. A total of 21 (84%) cases of the severe hypertensive placenta had higher copy numbers 100-110 vs only 13 (52%) cases had copy numbers 100-105 in the normotensive group. The difference in copy number value between them was statistically significant with p-value of 0.03. Conclusion: Present study findings suggest significant alterations at the level of the mitochondria in placenta from women with gestational hypertension, which may well contribute to gestational hypertension pathophysiology. Future research should include direct measure of placental and maternal whole body mitochondrial function, and assays that elucidate the potential modifiers of this association.

Abstract Background There is limited evidence regarding the relationship between lipid parameters and vascular mechanical characteristics in the normotensive population without diabetes mellitus. The aim of this study was to identify an association between lipid parameters and changes in vascular mechanical characteristics between men and women, and in women before and after menopause. Methods Six hundred-seventy patients who underwent vascular functional testing and who fulfilled the inclusion and exclusion criteria were enrolled in our cross-sectional study. All participants were from the Qinghai–Tibet Plateau (Luhuo County, Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China; mean altitude: 3860 m). Trained clinical physicians assessed brachial-ankle pulse wave velocity (Ba-PWV) and augmentation index adjusted to a 75-beats-per-minute heart rate (AIx@75). To investigate the relationship between lipid parameters and vascular mechanical characteristics in different sexes and menstrual stages, partial correlation analysis and multiple linear regression were used. Results The 670 participants comprised 445 women (103 post-menopausal). Mean Ba-PWV and AIx@75 were 1315.56 ± 243.41 cm/s and 25.07% ± 15.84%, respectively. Men had greater Ba-PWV values compared with women (1341.61 ± 244.28 vs 1302.39 ± 242.17 cm/s, respectively; P

Background: Pre-eclampsia is a major cause of maternal and fetal morbidity and mortality in both developed and developing countries. Hyperuricemia is often associated with pre-eclampsia and when this occurs, fetal outcome may become worse. We evaluated the role of maternal serum uric acid as a prognostic indicator of fetal outcome in pre-eclamptic mothers. Methods: A prospective case-control study in which 55 eligible pre-eclamptic patients at term were matched in maternal age and gestational age with 55 consecutive normotensive pregnant women. Venous blood samples were obtained and analyzed for serum uric acid. Following delivery, the fetal outcomes in the pre-eclamptic group and controls were determined. Data analysis was carried out using SPSS (version 21) and the level of statistical significance was set at p-value <.05. Results: The mean serum uric acid levels of the pre-eclamptic subjects was significantly higher compared to their normotensive counterparts (12.7 ± 7.8 vs. 4.9 ± 1.2 mg/dL, p = .000). Babies with low birth weight, poor Apgar scores (at 1st and 5th minute of life) and those who required neonatal unit admission occurred more significantly among the pre-eclamptic women when compared with the controls (p = .000). However, the live birth rate of the case and control groups was comparable (94.5% vs. 100%, p = .079), Binary logistic regression analysis revealed a positive association between hyperuricemia and pre-eclampsia (OR = 18.8; 95% CI = 1.22–289.35, p = .035). Pre-eclamptic mothers with hyperuricemia had 4.41 odds of delivering babies with low birth weight when compared with pre-eclamptics without hyperuricemia (OR = 4.41; 95% CI = 0.76–25.5, p = .097); but Apgar scores and need for neonatal admission showed no association with maternal serum uric acid levels. Conclusion: This study therefore suggests that hyperuricemia is a strong prognostic indicator of LBW babies among women with pre-eclampsia. [ABSTRACT FROM AUTHOR]

Introduction: The global prevalence of hypertension has increased to more than 25% of the world population, which is predicted to be increased to 65% by 2025. several studies have found that pediatric hypertensives have decreased heart rate variability (HRV) and higher sympathetic modulation/activation. Evidence suggests that this population may be predisposed to hypertension despite having high arterial blood pressure due to the likelihood of a genetic syndrome of abnormalities. This indicates that the development of hypertension in the children of hypertensives may be significantly influenced by cardiac autonomic dysfunction. Aims and Objectives: To evaluate the cardiac autonomic modulation in normotensive individuals of hypertensive parents compared to controls. Materials and Methods: This prospective study was conducted on 100 individuals, out of which 50 of them had a family history of hypertension and another 50 individuals without any family history of hypertension. Anthropometric measurements were taken along with weight, arterial blood pressure, and nerve conduction. Results: The study has found both systolic and diastolic pressure to be significant in the cold pressor test (p<0.05). It has also been shown that there is a significant difference between the two groups (p<0.05) in both the systolic and diastolic blood pressure, before and after Isometric Handgrip Test (IHGT). The study has found that heart rate variability is significantly different between the study and control group for each index (p<0.05). Conclusion: The study has found that the systolic and diastolic pressure is significantly higher in individuals with a family history of hypertension after performing the cold pressor test, isometric handgrip test and nerve conduction test (p<0.05). The study has shown that autonomic reactivity can be utilized to determine potential hypertension as a screening method for preventive diagnostics of hypertension. [ABSTRACT FROM AUTHOR]

In patients with diabetes, unrecognised hypertension is a serious problem risk factor for the development and progression of chronic complications. The study aimed to determine the prevalence of masked hypertension in normotensive diabetic patients, the factors affecting it, and its association with diabetes complications using ambulatory blood pressure monitoring (ABPM). A cross-sectional observational study was conducted on 150 normotensive diabetic patients. Patients were subjected to an interview and clinical examination to record demographic data, epidemiological data, and significant past history. ABPM was performed for each patient. Urine samples, echocardiogram, and ophthalmologic fundoscopy were done to check for diabetes-related complications. The mean age of all participants was 56.7 ± 7.8 years. A total of 93 patients (62%) were males. 99 (66%) patients had masked hypertension. A total of 85 (56.7%) were non-dippers, 49 (32.7%) were dippers, 1 (0.7%) was extreme dipper and 15 (10%) were reverse dippers. Non-dipping and reverse dipping were associated with concentric left ventricular hypertrophy LVH (p <.001). Masked hypertension was associated with concentric LVH (p =.001) and nephropathy (p =.008) whereas, nocturnal hypertension was associated with concentric LVH (p =.001) and nephropathy (p =.003). A single office blood pressure (BP) reading cannot rule out hypertension in patients with diabetes. Regardless of hypertension, clinicians should have all patients, especially patients with diabetes, undergo ABPM at least once. Masked hypertension, changes in nocturnal dipping and other phenomena that raise the risk of diabetes complications but cannot be measured by office BP can be measured by ABPM, and thus ABPM can provide a good prognostic benefit. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the association between maternal serum levels of TNF-α and preeclampsia.Methods: An analytical cross-sectional study involving 45 women diagnosed with preeclampsia and 45 healthy normotensive pregnant women matched for age, and gestational age at enrolment. Venous samples were collected from each participant after informed consent was obtained. Serum TNF-α level was determined using the human TNF-α competitive enzyme-linked immunosorbent assay (ELISA) technique with ELISA Kit. Hypothesis testing was done using the Chi-square test for categorical variables, the independent samples t-test and the Kruskal-Wallis test for numerical variables. All significances were reported at P < 0.05.Results: The median concentrations of TNF-α in women with preeclampsia of varying severity were significantly higher than those with normotensive pregnancies (P = 0.001). The median level of TNF-α was also significantly higher in patients with severe features of preeclampsia than in those without. The estimated cut-off levels of serum TNF-α were 15.6 ng/mL and 26.4 ng/mL respectively for the development and severity of preeclampsia. Maternal serum TNF-α level in preeclamptic patients is strongly correlated with systolic and diastolic BP, serum uric acid and alkaline phosphatase levels, proteinuria, and platelet count (P < 0.05).Conclusion: We can infer from this study that increased maternal serum levels of TNF-α may play a significant role in the pathogenesis of preeclampsia. We recommend further validation of these findings with a more robust longitudinal characterization of maternal serum TNF-α profiles in pregnancy through a well-designed prospective cohort study. [ABSTRACT FROM AUTHOR]

Pre-eclampsia is a common cause of maternal and perinatal morbidity and mortality. Studies have linked the condition to hypocalcaemia. The objective of this study was to determine the ionised calcium levels in pre-eclamptic women and compare with that of their normotensive counterparts. Two hundred and eighty-four (284) women who completed the study were analyzed. Half of the participants were pre-eclamptic and the other half were normotensive. The participants in the two groups were matched for age, gravidity, and gestational age. Venous blood was obtained from the antecubital vein and analyzed for ionised serum calcium. The mean ionised calcium concentrations between the two groups were compared using the student t-test. Results show the mean ages of the participants in the pre-eclamptic and normotensive groups were 24.47 ± 6.63 and 25.19 ± 5.71 years, respectively (p = 0.33). Pre-eclamptic subjects had significantly lower ionised serum calcium than the normotensive pregnant women (1.03 ± 0.11 mmol/L vs. 1.14 ±0.09 mmol/L, p < 0.001). There was also a significantly increased risk of hypocalcaemia amongst the pre-eclamptic pregnant women than the normotensive counterpart (OR=14.11, 95% CI: 6.16-32.35). Findings from this study suggest lower ionised calcium levels in serum and hypocalcaemia are associated indicators of preeclampsia among pregnant subjects diagnosed with the condition. Routine calcium supplementation is therefore recommended in pregnancy to reduce the risk of PE. [ABSTRACT FROM AUTHOR]

Physiological and biochemical changes during normal pregnancy may precipitate a state of insulin resistance (IR) without disrupting the body's physiology. The present study aimed to investigate the association between the indices of insulin sensitivity and blood pressure among normotensive and euglycemic pregnant women. The present cross-sectional study was conducted between February and December, 2021. It comprised 133 normal pregnant women who were non-diabetic and had normal blood pressure. The oral glucose tolerance test and fasting insulin levels were assessed, and the indices of insulin sensitivity and β-cell function were computed between the 24th and 28th weeks of gestation. A multivariate linear regression analysis was conducted to investigate the factors affecting systolic and diastolic blood pressure levels, including the indices of insulin sensitivity, β-cell function and others. Univariate linear analysis revealed that fasting insulin levels (β=0.95, P=0.027), the quantitative insulin sensitivity check index (QUICKI; β=-24.39, P=0.012) and diastolic blood pressure (β=0.76, P<0.001) were associated with systolic blood pressure. Of note, parity (β=0.83, P=0.031), fasting insulin levels (β=0.63, P=0.010), homeostasis model assessment of IR (HOMA-IR; β=3.19, P=0.013) and QUICKI (β=-11.97, P=0.029) were the factors that were associated with diastolic blood pressure. In the multivariate linear regression analysis, neither fasting insulin, nor QUICKI were found to be associated with systolic blood pressure. Fasting insulin levels (β=0.48; P=0.040), HOMA-IR (β=2.51; P=0.043) were associated with diastolic blood pressure. On the whole, in the present study, fasting insulin levels and HOMA-IR were associated with diastolic blood pressure levels without the emergence of high blood pressure readings or gestational diabetes. Further studies with a longitudinal approach are warranted to further identify associations with IR. [ABSTRACT FROM AUTHOR]

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110–115/70–75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of −1.37/−1.63 mm Hg and −2.79/−1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of −1.76 mm Hg and −2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.

The present study was designed to compare intraocular pressure (IOP) values by two types of tonometers in condition of normotensive and glaucomatous rat model. Glaucomatous eyes were induced by intracameral injections of hyaluronic acid in right eyes of six-week-old male Spargue-Dawley (SD) rats. Normotensive contralateral eyes were left eyes of the SD rats. IOP was measured using a rebound tonometer (Tonolab) and an immersive tonometer (Tonopen® XL) about 3:00 pm. The mean IOP values of normotensive control eyes were 10.80 ± 1.03 mmHg by Tonopen, and 15.10 ± 0.73 mmHg by Tonolab which were statistically insignificant (p = 0.1). The mean IOP values of glaucomatous experimental eyes were 30.20 ± 2.67 mmHg by Tonopen, and 37.90 ± 2.73 mmHg by Tonolab which were statistically insignificant (p = 0.95). High IOP values of glaucomatous eyes by two types of tonometers had strong positive correlation with each other (r = 0.904, p

Introduction: The prehospital decision of whether to triage a patient to a trauma center can be difficult. Traditional decision rules are based heavily on vital sign abnormalities, which are insensitive in predicting severe injury. Prehospital lactate (PLac) measurement could better inform the triage decision. PLac’s predictive value has previously been demonstrated in hypotensive trauma patients but not in a broader population of normotensive trauma patients transported by an advanced life support (ALS) unit. Methods: This was a secondary analysis from a prospective cohort study of all trauma patients transported by ALS units over a 14-month period. We included patients who received intravenous access and were transported to a Level I trauma center. Patients with a prehospital systolic blood pressure ≤ 100 mmHg were excluded. We measured PLac’s ability to predict the need for resuscitative care (RC) and compared it to that of the shock index (SI). The need for RC was defined as either death in the emergency department (ED), disposition to surgical intervention within six hours of ED arrival, or receipt of five units of blood within six hours. We calculated the risk associated with categories of PLac. Results: Among 314 normotensive trauma patients, the area under the receiver operator characteristic curve for PLac predicting need for RC was 0.716, which did not differ from that for SI (0.631) (p=0.125). PLac ≥ 2.5 mmol/L had a sensitivity of 74.6% and a specificity of 53.4%. The odds ratio for need for RC associated with a 1-mmol/L increase in PLac was 1.29 (95% confidence interval [CI] [0.40 – 4.12]) for PLac < 2.5 mmol/L; 2.27 (1.10 – 4.68) for PLac from 2.5 to 4.0 mmol/L; and 1.26 (1.05 – 1.50) for PLac ≥ 4 mmol/L. Conclusion: PLac was predictive of need for RC among normotensive trauma patients. It was no more predictive than SI, but it has certain advantages and disadvantages compared to SI and could still be useful. Prospective validation of existing triage decision rules augmented by PLac should be investigated.

Background: Cardiovascular complications account for the highest mortality in diabetic patients, mainly due to coronary artery disease and congestive heart failure. Left ventricular hypertrophy (LVH) is an ominous prognostic sign and an independent risk factor for cardiac events which is frequently present in patients living with diabetes. Aims and Objectives: The aim of the study was to evaluate the LV mass and function in normotensive diabetes patients without antihypertensive medication. Materials and Methods: 100 normotensive diabetic patients were in study group and 100 control patients were studied. Hypertension and other known causes of LVH were excluded from the study. Data were analyzed using proper statistical method. Results: Left ventricular mass index (LVMI) is significantly higher in diabetic patients as compared to control population (P

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect up to 10% of pregnancies worldwide, despite improvements in maternal and neonatal care. HDP and its sequelae are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim: To study the efficacy of mid-second trimester serum b-hCG levels in the prediction of HDP. Materials and Methods: This was a longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at Shri BM Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India, between December 2020 and June 2022. All women with gestational age between 16-20 weeks were screened, and 163 pregnant women were enrolled in the study. Serum ß-hCG levels were measured at enrollment, and values were followed-up until delivery. The development of HDP was evaluated using statistical analysis, including Chi-square, Independent t-test, Receiver Operating Curve/Area under the ROC Curve (ROC/AUC), sensitivity, and specificity. A p-value of <0.05 was considered significant. Results: Of the 163 pregnant women enrolled, 49 (30.1%) developed HDP, while 114 (69.9%) remained normotensive. The mean age of the study population was 24±4 years. The mean serum ß-hCG level in the normotensive group was 55666 mIU/mL, while in the HDP group, it was 100124 mIU/mL, with a statistically significant p-value of 0.001. A cut-off value of 77817 mIU/mL showed 83.7% sensitivity and 92.1% specificity. Conclusion: This study suggests that serum b-hCG levels between 16-20 weeks can be used as a non-invasive predictor of HDP. It is a good predictor of HDP and could potentially improve prevention strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND Preeclampsia is one of the major conditions causing maternal morbidity and mortality throughout the world. Though the exact cause of preeclampsia is still unknown, endothelial dysfunction with associated intense vasospasm has been implicated in its causation. Elevated homocysteine levels comprise an independent Risk for vascular disease, direct endothelialtoxicity, failure of nitricacidoxide release and platelet abnormalities. Hence to prevent the vascular related pregnancy complications, our aim is to estimate homocysteine levels in preeclampsia. AIM To compare the levels of serum homocysteine and lipid profile in preeclamptic individuals and in normal pregnant women METHODS The study was conducted at Government Medical College /Government General Hospital, Nalgonda from January 2020 to December 2020. A total of 50 cases of preeclamptic women were taken for the study after satisfying the inclusion and exclusion criteria. Fifty healthy pregnant women were included in the study under the control group. All patients were evaluated in detail and serum homocysteine and lipid profile were assayed. RESULT Serum homocysteine levels was significantly high In cases compared to controls.(Pvalue0.001). CONCLUSION There was significant increase in serum homocysteine in preeclamptic patients compared to the controls. This study explores the possibility of findingserum Marker to explain the endothelial dysfunction in preeclampstic patients. This valuable information would be helpful in proper medical intervention. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia affects the health of the mother and the fetus during pregnancy and childbirth. To date, little is known about the impact of preeclampsia on postpartum health-related to quality of life (HRQoL) in the Sidama region of southern Ethiopia. This study aimed to measure the HRQoL and its contributing factors among postpartum women with preeclampsia in the Sidama region.Methods: A prospective cohort study was conducted by enrolling pregnant women at ≥20 weeks of gestation up until the 37th week of gestation. We then followed them until 12 weeks after delivery. A locally validated, World Health Organization Quality-of-Life-BREF (WHOQOL-BREF) tool was used to assess participants' HRQoL at two time points; the 6th and 12th weeks postpartum. Assessment of HRQoL of participants was based on total scores on the WHOQoL-BREF. Higher scores on the WHOQoL-BREF reflected a higher HRQoL. Multiple linear regression analyses were performed to evaluate the contributing factors to HRQoL. The level of significance was determined at a p-value of < 0.05.Results: The HRQoL of postpartum women with preeclampsia significantly improved over time from 6 (151 ± 17) to 12 weeks (167 ± 18), p < 0.001). However, the overall HRQoL scores were lower (156 ± 16, p < 0.001) among women with preeclampsia compared to normotensive women (181 ± 21). An experience of early neonatal death was found to have a significant negative effect on the HRQoL of women with preeclampsia [β = - 2.1, 95% CI: - 3.43- - 0.85] compared to normotensive women who did not have early neonatal death. At 6 weeks of the postpartum period, the physical domain was found to have a significantly higher contribution to the lower HRQoL [β = 1.04, 95% CI: 0.88-1.12] compared to normotensive women, while other factors were constant.Conclusions: The HRQoL of women with preeclampsia improved over time from 6 to 12 weeks in the postpartum period. Lower HRQoL was observed among postpartum women with preeclampsia, especially among those who experienced preterm birth or early neonatal death. The effects of preeclampsia on the HRQoL of postpartum women should be considered in redesigning postnatal care intervention services. [ABSTRACT FROM AUTHOR]

Background: Autosomal dominant polycystic kidney disease (ADPKD) also known as Adult Polycystic Kidney Disease (APKD) is one of the most common systemic hereditary diseases. The disease usually presents between 20 to 39 years of age, although milder forms may not present until over 60 years and absence of renal failure has been rarely observed in some patients up to 80 years of age. Three distinct gene defects have been implicated in the pathogenesis ofAPKD designated as PKD1, PKD2, and PKD3. Patients with APKD may be asymptomatic, or may usually present with hypertension (in 50-70% of cases), renal insufficiency, and the complications of multiple cysts (haematuria, pain and infection) or as an abdominal mass discovered on incidental clinical or imaging examination. APKD is said to be rare in Africans. Case report: We report a case of an incidental finding of autosomal dominant polycystic kidney disease (ADPKD) in a 52-year-old normotensive man with a normal renal function test. Haematuria, dysuria and low-grade fever were the presenting complaints. The role of radiology in the diagnosis and management of ADPKD was highlighted. Conclusion: Although APKD is rare in Africans, a high index of suspicion for the disease is essential for the diagnosis of the disease especially in elderly patients with a family history of APKD who present with haematuria associated with multiple renal cysts.

AimHypertension is among the most prevalent chronic diseases with diverse etiology, affecting over 1 billion people globally. In numerous studies, vitamin C inversely correlated with blood pressure and was suspected to have antihypertensive properties. Currently, there is conflicting evidence regarding the relationship between vitamin C and blood pressure, with most studies being conducted on hypertensive subjects. The principal objective of this project was to investigate the relationship between vitamin C and blood pressure in normotensive adult subjects.MethodsA total of 2,533 individuals aged 20 years and above were enrolled in the present study from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). Serum vitamin C was regarded as an independent variable. EmpowerStats software and R (version 3.4.3) were used to examine the association between vitamin C and SBP or DBP.ResultsVitamin C was reversely correlated with both SBP (β = −0.02, 95% CI: −0.03 to −0.00, p = 0.0306) and DBP (β = −0.02, 95% CI: −0.04 to −0.01, p =

Background: There is limited evidence regarding the relationship between lipid parameters and vascular mechanical characteristics in the normotensive population without diabetes mellitus. The aim of this study was to identify an association between lipid parameters and changes in vascular mechanical characteristics between men and women, and in women before and after menopause.Methods: Six hundred-seventy patients who underwent vascular functional testing and who fulfilled the inclusion and exclusion criteria were enrolled in our cross-sectional study. All participants were from the Qinghai-Tibet Plateau (Luhuo County, Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China; mean altitude: 3860 m). Trained clinical physicians assessed brachial-ankle pulse wave velocity (Ba-PWV) and augmentation index adjusted to a 75-beats-per-minute heart rate (AIx@75). To investigate the relationship between lipid parameters and vascular mechanical characteristics in different sexes and menstrual stages, partial correlation analysis and multiple linear regression were used.Results: The 670 participants comprised 445 women (103 post-menopausal). Mean Ba-PWV and AIx@75 were 1315.56 ± 243.41 cm/s and 25.07% ± 15.84%, respectively. Men had greater Ba-PWV values compared with women (1341.61 ± 244.28 vs 1302.39 ± 242.17 cm/s, respectively; P < 0.05), while AIx@75 values were higher in women compared with men (27.83% ± 15.85% vs 19.64% ± 14.40%, respectively; p < 0.001). In the partial correlation analysis adjusted for age, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (HDL-C) were associated with Ba-PWV in both men and women (p < 0.05); however, the magnitude was larger in men. Statistical significance was not seen for AIx@75 among both men and women. Multiple linear regression analysis revealed that TC (β = 0.165, p = 0.024) and non-HDL-C (β = 0.151, p = 0.042) remained independent predictors of change in Ba-PWV in men after adjusting for age, mean arterial pressure, waist circumference, hemoglobin, platelet count, fasting blood glucose, estimated glomerular filtration rate, and uric acid. After adjusting for traditional cardiovascular risk factors, pre-menopausal women had a similar association to that of men between LDL-C (β = 0.126, p = 0.030), non-HDL-C (β = 0.144, p = 0.013), TC/HDL-C (β = 0.162, p = 0.005), LDL-C/HDL-C (β = 0.142, p = 0.013) and Ba-PWV; however, post-menopausal women had no association between the lipid parameters and vascular function.Conclusions: Overall, TC and non-HDL-C were independent associated factors for vascular compliance alterations evaluated through Ba-PWV in normotensive men. In pre-menopausal women, LDL-C, non-HDL-C, TC/HDL-C and LDL-C/HDL-C were independent associated factors for vascular compliance alterations. After controlling for traditional risk factors, lipid profiles were not associated with these metrics for AIx@75, which can measure the amplification of reflex flow, because of the high number of confounding factors that do not genuinely reflect changes in vascular characteristics. Lipid factors did not appear to be linked to vascular function in post-menopausal women. [ABSTRACT FROM AUTHOR]

Anutsara Promket,1 Chatuporn Duangkum,1 Yuttapong Wongswadiwat,2 Piyamas Saksiriwuttho,1 Sukanya Chaiyarach,1 Kiattisak Kongwattanakul,1 Ratana Komwilaisak,1 Pisake Lumbiganon,1 Prapassara Sirikan3 1Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Chatuporn DuangkumDepartment of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Muang District, Khon Kaen, 40002, ThailandTel +66 653241590Email Chatudu@kku.ac.thObjective: To compare fetal and neonatal cardiac functions in terms of global, systolic, and diastolic function between the preeclampsia and normotensive blood pressure of pregnancies.Methods: A prospective cohort study was conducted at a university hospital in Northeast Thailand. Twenty-nine pregnancies diagnosed as preeclampsia with or without severe features were compared with 29 normotensive pregnancies. Global cardiac, systolic, and diastolic function were assessed at prenatal and postnatal periods, by a professionally trained obstetrician and pediatric cardiologist, respectively.Results: The fetal left modified myocardium performance index (Mod-MPI) in preeclampsia and normotensive blood pressure were 0.60± 0.08 and 0.59± 0.08 (p-value=0.341), respectively, while fetal right Mod-MPI were 0.57± 0.16 and 0.54± 0.21 (p-value=0.861), respectively. There were no statistically significant differences in terms of fetal isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), aortic peak systolic velocity (Ao PSV), pulmonary artery peak systolic velocity (PA PSV), mitral valve (MV) E:A ratio, or tricuspid valve (TV) E:A ratios between the two groups. Neonatal mitral valve E peak systolic velocity (MV-E PV) in preeclamptic and normotensive blood pressure groups were significantly different at 51.1± 8.02 cm/s and 43.56± 5.21cm/s (p-value=0.036), respectively, whereas neonatal left Mod-MPI, mitral valve A peak systolic velocity (MV-A PV), MV E:A ratio, and Ao PSV were not significantly different (p-value=0.436, 0.119, 0.379, and 0.709), respectively.Conclusion: Neonatal MV-E PV of the preeclampsia group was significantly higher than the normotensive blood pressure group, while there were no statistically significant differences in terms of global cardiac and diastolic functions during the fetal period between two groups.Keywords: fetal Mod-MPI, neonatal Mod-MPI, preeclampsia, normotensive

Li Ma,1 Hong Li,1,2 Huijun Zhuang,1 Qiao Zhang,1 Nianchun Peng,1 Ying Hu,1 Na Han,1 Yuxing Yang,1 Lixin Shi1 1Department of Endocrinology and Metabolism, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China; 2School Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of ChinaCorrespondence: Hong LiDepartment of Endocrinology and Metabolism, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi Road, Guiyang, Guizhou, 550001, People’s Republic of ChinaTel +8618685136016Fax +86-851-86770523Email lee-helen@sjtu.edu.cnPurpose: The study was conducted to investigate metabolic syndrome (MS) incidence within the normal blood pressure (BP) range in a population over 40 years old in an urban area of Guiyang, Guizhou Province, China, and to identify a valid BP cutoff value for predicting MS.Materials and Methods: Data from this study are based on the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. In total, 2935 subjects in the normal BP range and without MS (795 males, 2140 females) aged 40– 80 years were included in this study. Follow-up subjects were classified by baseline BP and grouped by age. After the 3-year follow-up, the MS incidence and valid BP cutoff value for predicting MS were calculated for subjects within the normal BP range.Results: After the 3-year follow-up study, the crude and standardized MS incidences in the cohort were 19.83% and 16.89% for follow-up subjects, respectively, with incidences of 10.94% and 10.50% for males and 23.13% and 20.66% for females. The incidence of MS in normotensive subjects (15.53%) was lower than that in subjects with high-normal BP (29.08%). After adjusting for age, sex, BMI, smoking, and drinking, the risk of having MS in the high-normal BP group was 1.823-fold [HR 1.823 95% CI (1.538– 2.162)] higher than that in the normotensive group. The ROC curve showed that the BP cutoff values were more than 117/74 mmHg in males and 112/74 mmHg in females.Conclusion: When BP was within the normal range, the incidence of MS in participants was very high. The MS incidence was higher among high-normal BP subjects than among normotensive subjects, as was the risk of having MS. The valid BP cutoff value for predicting MS in the population was 117/74 mmHg in males and 112/74 mmHg in females. Currently, epidemiological investigations are needed to determine whether a lower BP cutoff value is needed in diagnosing MS.Keywords: metabolic syndrome, high-normal blood pressure, normotensive, incidence, cutoff value

Abstract The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. The author explored the association between non‐interventional weight alterations and BP changes in a large cohort of normotensive adults. This is a retrospective analysis of normotensive individuals, between 2010 and 2018. All weight changes were non‐interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% ("large reduction"), between 2.5% and 5% ("moderate reduction"), reduction of

Abstract Background Hypovitaminosis D in pregnancy is associated with adverse health outcomes in mothers, newborns and infants. This study assessed the levels of 25-hydroxyvitamin D [25(OH)D] in normotensive pregnancies and in preeclampsia, evaluated the association between vitamin D deficiency and preeclampsia risk; and determined the foeto-maternal outcome in preeclamptic women with vitamin D deficiency. Methods This case-control study was conducted among pregnant women who visited the Comboni Hospital, in Ghana from January 2017 to May 2018 for antenatal care. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Socio-demographic, clinical and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of 25- hydroxyvitamin D [25(OH)D] using enzyme-linked immunosorbent assay technique. Lipids (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) were also estimated. Results A total of 81.7% of the study participants had vitamin D deficiency. Of these, 88.6% of the women with PE had vitamin D deficiency compared to 75.0% in the NP. Vitamin D levels were significantly reduced in the PE women compared to the normotensive pregnant women (p = 0.001). A higher proportion of the preeclamptic women who were vitamin D deficient had preterm delivery (p

Introduction: Hypertension, diabetes, and heart diseases are very common and silent noncommunicable diseases. If ignored, these will be life-threatening. As per recent yoga researches on hypertension, some of the yoga practices such as pranayama, meditation, and Kriya yoga have found to be very effective in managing hypertension and thereby controlling its adverse effects. Hence, the present study is undertaken to understand the effect of simple Bhramari pranayama on both hypertensive and normotensive individuals so as to help standardize this Pranayama and advise it as a preventive measure in the management of hypertension. Methods: The present study is a single-arm clinical trial. Ninety-seven participants, both male and females of age ranging from 30 to 60 years, were approached as the study participants. Of the 78 complying participants, 44 participants were hypertensive and 34 normotensives. A yoga expert taught Bhramari Pranayama one to one to all the participants. They were called on the following day for recording their blood pressure (BP) and pulse rate (PR) before and immediately after the thirty rounds of the practice. Results: Simple Bhramari Pranayama significantly lowered the systolic blood pressure (SBP) (P < 0.001), diastolic blood pressure (DBP) (P < 0.001*), and PR (P < 0.001*) of the hypertensive individuals (P < 0.001*). In the normotensives group also, a significant decrease in SBP (P < 0.001*), DBP (P < 0.05) and PR (P < 0.001*) was evident. However, the changes evident in normotensives were well within the normal range of BP and PR. Conclusion: The present study concludes that simple Bhramari Pranayama has significantly reduced the BP and PR in the hypertensive as well as in the normotensive participants immediately after its practice. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular complications account for the highest mortality in diabetic patients, mainly due to coronary artery disease and congestive heart failure. Left ventricular hypertrophy (LVH) is an ominous prognostic sign and an independent risk factor for cardiac events which is frequently present in patients living with diabetes. Aims and Objectives: The aim of the study was to evaluate the LV mass and function in normotensive diabetes patients without antihypertensive medication. Materials and Methods: 100 normotensive diabetic patients were in study group and 100 control patients were studied. Hypertension and other known causes of LVH were excluded from the study. Data were analyzed using proper statistical method. Results: Left ventricular mass index (LVMI) is significantly higher in diabetic patients as compared to control population (P<0.001). It was also observed that the means of the left ventricular posterior wall thickness, interventricular septal thickness, and the left ventricular internal diameter during diastole (in all cases P<0.001) were statistically significantly high in diabetic patients in comparison to healthy control subjects. We have found that a significant systolic dysfunction in diabetic group and diastolic dysfunction also very common in diabetic group than the control group. The LVMI also increased in patients who have longer duration of diabetes and poor glycemic control. Conclusion: LVM is significantly higher in patients of type 2 diabetic without having hypertension, albuminuria, and apparent ischemic heart disease as compared to healthy controls. LVM in diabetic patients increases with duration of diabetes and is positively correlated with HbA1c and blood sugar level. [ABSTRACT FROM AUTHOR]