Tag: nevin manimala

J Cardiovasc Med (Hagerstown). 2025 Jun 1;26(6):284-296. doi: 10.2459/JCM.0000000000001733. Epub 2025 May 21.

ABSTRACT

BACKGROUND: Dilated cardiomyopathy (DCM) is a common cause of heart failure with reduced ejection fraction (HFrEF) in industrialized countries and a major contributor to morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in HFrEF management; however, their impact on endothelial function in this patient population remains less explored. This study aims to evaluate the effects of SGLT2i on endothelial function and echocardiographic parameters in patients with DCM.

METHODS: This observational, longitudinal, monocentric study enrolled patients with DCM and HFrEF. Endothelial function was assessed using peripheral arterial tonometry (EndoPAT) at baseline, 6 months, and 12 months following the initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i). The enrollment period spanned from November 2021 to November 2022. The primary endpoint was the change in reactive hyperemia index (RHI) over time. In addition, a subgroup analysis was conducted to compare the effects of different SGLT2i agents (empagliflozin vs. dapagliflozin) and DCM etiology (ischemic vs. idiopathic) on endothelial function.

RESULTS: A total of 102 patients were included, predominantly male (72%), with a median age of 75 years and an average baseline left ventricular ejection fraction (LVEF) of 32.9 ± 7.9%. NYHA class II/III was observed in 76% of participants, and ischemic etiology accounted for 53% of DCM cases. The baseline RHI value was 1.15 ± 0.34. At 6 months, it significantly increased to 1.40 ± 0.34 (P < 0.0001), reflecting an absolute change of 0.25 ± 0.03 (ΔRHI baseline – 6 months). Between 6 and 12 months, the RHI showed a further significant increase to 1.69 ± 0.36 (P < 0.0001), with an additional change of 0.29 ± 0.03 (ΔRHI 6 – 12 months). The overall change in RHI from baseline to 12 months (ΔRHI baseline – 12 months) was 0.54 ± 0.04 (P < 0.0001). No significant differences in RHI were observed between patients treated with dapagliflozin and those receiving empagliflozin (P = 0.589), nor between different DCM etiologies (ischemic vs. idiopathic, P = 0.463). The enhancement in RHI was associated with a reduction in the incidence of hospitalization for heart failure (AUC 0.783, P < 0.001). Progressive improvement in left ventricular function was observed through echocardiographic parameters. Although EDV and ESV showed a decreasing trend (EDV: 176.2 ± 64.9 to 167.6 ± 31.1 ml, P = 0.335; ESV: 124.5 ± 52.7 to 116.8 ± 24.6 ml, P = 0.606), these changes were not statistically significant. LVEF improved significantly from 32.9 ± 7.9% at baseline to 36.8 ± 5.5% at 6 months and 37.1 ± 4.9% at 12 months (P < 0.001). The E/A ratio declined from 1.5 ± 0.5 to 1.1 ± 0.3 (P = 0.023) and the E/E’ ratio decreased from 18.1 ± 5.1 to 11.1 ± 2.8 (P = 0.027).Left atrial volume significantly decreased from 108 to 100 ml (P = 0.041), and pulmonary artery systolic pressure dropped from 44 to 39 mmHg at 6 months and 35 mmHg at 12 months (P < 0.001).

CONCLUSION: SGLT2i therapy significantly improves endothelial function in patients with DCM suggesting a potential vascular benefit beyond their well established cardioprotective effects.

PMID:40472172 | DOI:10.2459/JCM.0000000000001733

Aust J Prim Health. 2025 Jun;31:PY25020. doi: 10.1071/PY25020.

ABSTRACT

Background Inaccessibility of primary healthcare services in rural and remote communities is argued to lead to higher rates of potentially preventable hospitalisations. This research aimed to develop an explanatory method that could be applied for investigating a rural setting considered high risk for potentially preventable hospitalisations, and to describe how to improve place-based pathways to primary healthcare services that would prevent potentially preventable hospitalisations. Methods The method described in this paper provides a structured and detailed plan for examining regions identified as high risk for a particular potentially preventable hospitalisation condition. The method was developed and tested through a series of research studies on ear, nose and throat (ENT) conditions in the Murray Primary Health Network, that had regions identified as high-risk hotspots for ear, nose and throat potentially preventable hospitalisations. Results The procedure developed for investigating hotspot regions of potentially preventable ear, nose and throat hospitalisations included six steps: (1) develop investigative questions; (2) identify and select potentially preventable hospitalisations condition and region; (3) literature review of best practice service needs and service mapping; (4) healthcare provider and consumer experiences; (5) illustrate patient journey; and (6) summarise recommendations for primary health care. Conclusions This method provides an understanding of the access pathways to primary healthcare services, and identifies where interventions and prevention strategies would support residents in obtaining equitable health care. This developed method can be further applied and tested as a mechanism for health and service needs assessment by primary healthcare planning and coordination agencies, which in Australia include Primary Health Networks, public health units and hospital networks.

PMID:40472135 | DOI:10.1071/PY25020

Nutr Rev. 2025 Jun 5:nuaf068. doi: 10.1093/nutrit/nuaf068. Online ahead of print.

ABSTRACT

CONTEXT: It has been proposed that supplementation with milk protein (MP) may ameliorate lipid profiles, lower blood pressure (BP), reduce oxidative stress (OS), and regulate liver enzyme levels to prevent cardiovascular disease.

OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) investigated the impacts of casein protein, whey protein, and MP supplementation on lipid profiles, BP, OS, and liver enzymes in adults.

DATA SOURCES: A systematic search strategy was developed to determine relevant RCTs published up to September 2024 among several databases (Medline/PubMed, Web of Science, and Scopus).

DATA EXTRACTION: The extracted data comprised a range of trial characteristics, including the study design, sample size, demographic data of participants, trial duration, pre- and post-assessments of the outcomes, and the dosage of MP supplements.

DATA ANALYSIS: A random-effects meta-analysis was performed to determine the effects of MP supplementation on the measured outcomes. Heterogeneity across the trials was evaluated using the I2 statistic and Cochran’s Q tests. The pooled analysis of 65 RCTs revealed that MP supplementation significantly reduced levels of total cholesterol (TC) (weighted mean difference [WMD]: -4.03 mg/dL; 95% CI: -7.91, -0.16; P = .042), systolic blood pressure (SBP) (WMD: -1.99 mmHg; 95% CI: -3.16, -0.82; P < .001), and triglycerides (TG) (WMD: -6.11 mg/dL; 95% CI: -9.78, -2.44; P = .001) in the MP group compared with the untreated group. However, there were no statistically substantial impacts on diastolic blood pressure, serum levels of glutathione, nitric oxide, apolipoprotein (Apo) A, high-density-lipoprotein cholesterol, Apo B, alanine transaminase, malondialdehyde, aspartate transaminase, and low-density-lipoprotein cholesterol.

CONCLUSION: Supplementation with MP may have hypotensive and hypolipidemic effects, as indicated by reductions in SBP, TG, and TC.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42024621220.

PMID:40471664 | DOI:10.1093/nutrit/nuaf068

Iran J Allergy Asthma Immunol. 2025 May 5;24(3):396-402. doi: 10.18502/ijaai.v24i3.18687.

ABSTRACT

The quantity and quality of anti-Spike (anti-S) antibodies, rapidly elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are necessary for understanding the immune response induced by infection. Antibody avidity is a good indicator of the quality of antibody response. Interleukin (IL)-21 and IL-27 are two cytokines that play vital roles in the affinity maturation process. Therefore, we decided to investigate whether there are any relationships between the avidities of antibodies against spike and nucleocapsid (N) antigens of SARS-CoV-2 and serum levels of these cytokines in symptomatic and asymptomatic coronavirus disease 2019 (COVID-19) patients. Forty symptomatic COVID-19 patients and 40 asymptomatic carriers were enrolled. Anti-S and anti-N IgG avidity indices (AIs) were determined using a modified enzyme-linked immunosorbent assay (ELISA). Serum levels of IL-21 and IL-27 were quantified by specific ELISA kits. AI values of both anti-S and anti-N IgG were lower in the symptomatic group compared to asymptomatic cases, while only that of anti-N IgG was statistically significant. For IL-21 and IL-27 serum levels, no significant difference between the two groups was shown. Also, we could not find any correlations between cytokine levels and antibody AI values. However, an inverse correlation between anti-S AI value and IL-27 serum level was found in asymptomatic patients. Our study suggests that serum levels of IL-21 and IL-27 cannot predict differences in anti-S and anti-N IgG avidity between symptomatic and asymptomatic COVID-19 patients.

PMID:40471646 | DOI:10.18502/ijaai.v24i3.18687

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e16642023. doi: 10.1590/1413-812320242911.16642023. eCollection 2025.

ABSTRACT

The aim is to verify the trend in infant mortality (IM) and preventable infant mortality (PIM) in municipalities in the metropolitan region of Porto Alegre from 1996 to 2021 and their associations with per capita public spending on health and population coverage of the Family Health Strategy (FHS). Ecological study with data from information systems: on mortality, live births, public budgets and primary health care. The deaths described in the Ministry of Health’s list were considered preventable. Statistical analysis used Prais-Winsten regression. A decrease in MIE was observed in the municipalities studied with the exception of Esteio. There was an association between per capita public spending on health and the study outcomes in Novo Hamburgo, Canoas and Porto Alegre. An association was found between the FHS coverage and IM in Novo Hamburgo, Sapucaia do Sul, Canoas and Porto Alegre. PIM was associated with FHS coverage in Novo Hamburgo, Canoas and Porto Alegre. Despite the decrease in the IM and PIM coefficients, the association of this indicator was more impacted by per capita public spending on health than by the FHS population coverage.

PMID:40471615 | DOI:10.1590/1413-812320242911.16642023

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e16402023. doi: 10.1590/1413-812320242911.16402023. eCollection 2025.

ABSTRACT

Hospitalizations for ambulatory care sensitive conditions (ACSCs) are preventable with adequate primary care (PC). For the elderly population, they are important due to their greater vulnerability to chronic diseases and comorbidities. Objective: to carry out an integrative review of articles on ACSCs in the elderly and their correlation with indicators of access to primary care. The research was carried out on the BVS and PUBMED databases. Inclusion criteria: relationship between ICSAP and PA, publications from 2000 to 2022, analysis of the elderly age group, statistical methods, Portuguese, Spanish or English languages and indexing in peer-reviewed journals. We identified 315 publications and selected 15, 12 of which focused on the elderly population. The South and Southeast regions were the most analyzed, and the year most investigated was 2012. Coverage of the Family Health Strategy was the most commonly used indicator. A reduction in ACSC rates in the elderly was positively correlated with access to PHC. Monitoring ACSCs is an important tool for managing the health of the elderly, with PH playing a strategic role in reducing hospitalizations, minimizing risks and promoting healthy ageing.

PMID:40471614 | DOI:10.1590/1413-812320242911.16402023

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e01402024. doi: 10.1590/1413-812320242911.01402024. eCollection 2025.

ABSTRACT

The International Statistical Classification of Diseases and Related Health Problems (ICD) allows the systematization of health statistics around the world. This study describes the origin, functionalities, forms of construction and updating of the CID, through a qualitative, exploratory and descriptive study focusing on document analysis, considering official documents and technological tools. Since its creation, the ICD has been revised and published, reflecting its connection to advances in health, science and society. Such reviews were accompanied by many studies, debates and consensus. The current version of the ICD, called ICD-11, in addition to traditional content revisions, has been transformed to better adapt to the digital world. This new version has been available in Portuguese since February 2024 and its implementation is in process in Brazil – a fact that requires preparation from all operators of the Unified Health System.

PMID:40471591 | DOI:10.1590/1413-812320242911.01402024

Cien Saude Colet. 2025 Jun 2;30(suppl 1):e01312023. doi: 10.1590/1413-812320242911.01312023. eCollection 2025.

ABSTRACT

This article analyzed the possible shifts in the senses and meanings of obesity for primary care health professionals in Bahia after a health education initiative. A qualitative study carried out with 37 participants, which used a semi-structured online questionnaire and method triangulation (Free Word Association Technique – prototypical analysis, open question – content analysis, and Obesity Development Factors – descriptive statistical analysis). The Concept and Etiological Approaches categories revealed significant inflections in the senses and meanings of obesity, beyond the biological and biomedical model, in dialogue with the ecological, syndemic, and multifactorial approaches, in addition to evocating anthropological perspectives and body diversity. They also revealed the assumption of concerns about the prevalence and resolution of care practices, the question of the uniqueness of obesity, and the limitation of the evaluation method by Body Mass Index, evidence that contributes to the reflection of health education in the structuring of curricula to the light of the multifactorial nature and complexity of this phenomenon.

PMID:40471590 | DOI:10.1590/1413-812320242911.01312023

Biochem J. 2025 May 14:BCJ20240621. doi: 10.1042/BCJ20240621. Online ahead of print.

ABSTRACT

Constipation is a forerunner to Parkinson’s disease (PD) diagnosis, worsening thereafter. We explore the relationship of intestinal barrier dysfunction to constipation, and whether intestinal fungal load is an aggravating factor. Fungal load was quantified by real-time PCR, using ITS1F-ITS2 primer-set, on microbial DNA-extract from stool in 68 participants with PD, 102 without. Fungal load was 60% higher per decade after age 60 years, with no PD-status interaction with age. After age adjustment, it was associated inversely with dietary renal acid load. It was unrelated to presence of constipation or barrier dysfunction. Neither consumption of antimicrobials nor of other targeted exogenous substances was associated. Enzyme-linked-immunosorbent assays measured barrier dysfunction markers, faecal alpha-1 antitrypsin and zonulin and serum intestinal-fatty-acid-binding-protein. Barrier dysfunction was associated with constipation and slower colonic transit. Functional constipation was 28% more frequent with a doubling of alpha-1 antitrypsin concentration. More colonic-transit-test markers were retained in transverse colon, the higher alpha-1 antitrypsin and zonulin concentrations, anatomically spotlighting abnormality for entire colon. In contrast, the concentration of the small intestinal barrier marker, fatty-acid-binding-protein, was associated with looser stool consistency, that is consistent with secondary microbial overgrowth. By showing the relationship of intestinal barrier dysfunction to constipation, this study supports the hypothesis that dysfunction may be consequential. Dysfunction may be a necessary, but not sufficient, precursor to PD, in allowing inflammaging. Since ageing is the clearest risk for PD, a gut pathogen escalating in abundance from the sixth decade, integral to fungal load, whose reproduction and virulence is favoured by alkalinity, tallies.

PMID:40471586 | DOI:10.1042/BCJ20240621

JAMA Netw Open. 2025 Jun 2;8(6):e2513807. doi: 10.1001/jamanetworkopen.2025.13807.

ABSTRACT

IMPORTANCE: Inequities in pediatric health care services persist in Bangladesh, with critical disparities between public and private hospitals, particularly for children younger than 5 years. These disparities hinder progress toward equitable health care access and quality outcomes.

OBJECTIVE: To evaluate the availability and quality of health care workforce and service coverage for children younger than 5 years in public and private hospitals in Bangladesh to identify gaps in infrastructure, workforce distribution, and adherence to pediatric care standards.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from October 13, 2023, to May 24, 2024. Data collection included facility assessments, structured questionnaires, and direct observations using World Health Organization (WHO)-adapted tools. The study covered both private and public hospitals across 6 subdistricts in Bangladesh, representing a mix of urban and rural populations. Senior hospital staff and administrators were surveyed. Inclusion criteria were general inpatient and outpatient pediatric care delivered in hospitals. Diagnostic centers and specialized facilities were excluded.

EXPOSURES: Availability of pediatric infrastructure, workforce, essential medications, and adherence to clinical guidelines assessed against WHO standards.

MAIN OUTCOMES AND MEASURES: The primary outcomes included the presence of pediatric-specific departments, neonatal care facilities, and trained personnel and adherence to WHO care standards. Data were analyzed using descriptive statistics and χ2 tests to highlight disparities.

RESULTS: The study sample included 102 private and 7 public hospitals. A significantly higher proportion of public hospitals compared with private hospitals had pediatric inpatient departments (100% vs 39.2%), newborn wards (100% vs 12.8%), and trained nurses (100% vs 32.4%). Only private hospitals in the sample had neonatal intensive care units (6.9% vs 0%). Pediatricians were available for extended consultations at a greater proportion of public hospitals compared with private hospitals (71.4% vs 26.5%).

CONCLUSIONS AND RELEVANCE: These findings show substantial disparities in the availability of pediatric health care services between public and private hospitals in Bangladesh. Addressing these disparities through workforce investment and infrastructure improvements is crucial for equitable child health care and better health outcomes.

PMID:40471581 | DOI:10.1001/jamanetworkopen.2025.13807