Pulmonary Hypertension (PH) is a heterogeneous condition defined by a mean pulmonary artery pressure (mPAP) >20 mmHg at rest, confirmed via right heart catheterization. PH can be classified into several groups based on underlying mechanisms, and mixed type PH involves overlapping features from different categories. We report a case of a 49-year-old woman with a history of HIV infection and hyperthyroidism who presented with progressive shortness of breath. Transthoracic echocardiography suggested severe pulmonary hypertension, while further evaluation revealed a combination of pre-capillary and post-capillary components, consistent with mixed type PH. Contributing factors included HIV-associated pulmonary vasculopathy and hyperthyroidism-induced high-output cardiac failure. The patient was treated with intravenous Furosemide, Beraprost sodium, Spironolactone, Digoxin, Warfarin, and Omeprazole. During hospitalization, she developed distributive shock requiring norepinephrine infusion. This case highlights the importance of thorough diagnostic evaluation to identify multifactorial causes of PH, especially in patients with coexisting HIV infection and hyperthyroidism. Management strategies should be tailored to address the complex interplay of underlying conditions while considering drug interactions and local therapeutic resources.

Mangosteen peel extract is a xanthone group, that plays an important role in anti-angiogenesis. This study investigated mangosteen peel extract on cerebral neovascularization in type 2 diabetes mellitus (DM) rats. This study used 36 rats, randomized into six groups: C1 (negative control); C2 (high fat diet (HFD) and mangosteen peel extract at 200 mg/kg BW); C3 (HFD and diabetic); E1, E2, and E3 (HFD, diabetic, and extract at 100, 200, and 400 mg/kg BW respectively). All groups were measured body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR) and β cell function (HOMA-B), and histopathological feature of cerebral vascular (CV). There were significant differences in BMI, HOMA-IR, HOMA-B, and the mean number of CV (all p < 0.05) among treatment groups. E1-3 groups had a significantly lower level of blood glucose and HOMA-IR, and a higher level of HOMA-B and BMI (all p < 0.05) which tends to reduce cerebral neovascularization. HOMA-IR independently had a positive effect to induce neovascularization of CV (p < 0.05, R 2 = 26.8%). These findings suggested that mangosteen peel extract increased β-cell function sensitivity, and effectively suppressed insulin resistance, BMI, and cerebral neovascularization process in type 2 DM rats.

BACKGROUND: The aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation. METHODS: Forty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension (TcPO₂) was measured before and after infiltration, and changes in TcPO₂ were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation. RESULTS: Thirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. TcPO₂ readings showed significant decreases (P<0.05) following both one-per-mil tumescent (99.9±5.7 mmHg vs. 37.2±6.3 mmHg) and normal saline (103±8.5 mmHg vs. 48.7±5.9 mmHg) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis. CONCLUSIONS: One-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.
Constriction ; Epinephrine ; Groin ; Hand Injuries ; Ischemia ; Necrosis ; Oxygen ; Rats, Wistar ; Reading ; Reperfusion Injury ; Replantation ; Skin ; Vasoconstriction