BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

Purpose: Prematurity and low birth weight increase cardiovascular risk, including hypertension (HTN). However, the combined effect of these factors along with others in the development of HTN is unclear. This study aimed to identify changes in blood pressure in small-for-gestational-age (SGA) patients treated with recombinant human growth hormone (rhGH) by comparison with healthy controls. Methods: We conducted a case-control study with 72 SGA and healthy controls, aged 6 to 16 years. Blood pressure was assessed through office and 24-hour ambulatory blood pressure monitoring (ABPM) recordings (at least 40 measurements including daytime and nighttime), and results were compared between SGA children on rhGH treatment and healthy peers. Results: Forty-six SGA children (41% preterm) on rhGH therapy and 26 healthy controls were enrolled. Despite an average of 5 years of rhGH treatment, no significant difference in HTN frequency was found between groups. However, multiple regression analysis revealed a 0.451 increase in 24-hour diastolic blood pressure (DBP) standard deviation score (SDS) in SGA children on rhGH (P=0.032). Daytime DBP SDS was also increased (0.462; P=0.042). An inverse correlation between weight and gestational age at birth was established. SGA children in the prepubertal stage showed a greater increase in 24-hour DBP SDS than those in the pubertal stage (0.499; P=0.009). Overweight was independently associated with increased 24-hour (0.950; P=0.002) and daytime DBP SDS (1.005; P=0.001). Conclusion Prolonged rhGH treatment in SGA patients did not increase the risk of HTN. However, ABPM detected subtle changes that highlight the need for careful blood pressure monitoring in overweight prepubertal children.

Objectives: Chatbot technology improves access to and engagement with diabetes education. However, few studies have evaluated the feasibility and rigorously assessed the impact of chatbots among individuals with type 2 diabetes (T2DM) using theory-based approaches. This pilot study assessed the feasibility and preliminary impact of a chatbot on glycemic targets, loneliness, and perceived health beliefs among adults with T2DM. Methods: An explanatory mixed-methods approach, comprising a one-group experimental design and qualitative interviews, was used. The chatbot simulation, named “TakonGendhis,” was developed based on conceptual models derived from the technology acceptance model and the health belief model. Feasibility included usefulness, ease of use, and intention to use. Preliminary impact was evaluated based on changes in glycemic targets, loneliness, and health beliefs from baseline to 12 weeks post-intervention. Qualitative data were gathered through individual interviews and focus group discussions and were analyzed thematically. Narrative synthesis was employed to integrate findings from the quantitative and qualitative phases of the study. Results: The scores for usefulness, ease of use, and intention to use were 26.55, 27.32, and 34.03, respectively. Quantitative analysis revealed reduced loneliness, improved health beliefs, and lower glycemic scores after the 12-week intervention. The qualitative study identified 4 themes: feasibility, beliefs, emotional support, and areas for improvement. Conclusions The intervention was feasible and had beneficial preliminary impacts on glycemic targets, loneliness, and health beliefs. Addressing feasibility, beliefs, emotional support, and identified areas for improvement may increase patients’ willingness to use the chatbot.

Anti-neutrophil cytoplasmic antibody-associated vasculitides (AAV) are rare autoimmune disorders typically involving the lungs and kidneys. A few case reports have described an association with hematopoietic stem cell transplant (HSCT). We present a case of myeloperoxidase-positive AAV with predominant renal involvement in a 49-year-old male with a history of acute myeloid leukemia treated with allogenic HSCT and complicated by chronic graft-versus-host disease (GVHD). He presented with rapidly progressive glomerulonephritis, and kidney biopsy revealed pauci-immune necrotizing crescentic glomerulonephritis. Treatment with methylprednisolone pulses followed by oral prednisolone, rituximab, and plasmapheresis led to improved kidney function and a tailored rituximab maintenance regimen was followed. However, a renal-limited relapse occurred at 15 months, requiring repeat induction therapy. Dialysis was avoided, but renal function only partially recovered. This case suggests that AAV can develop after HSCT and GVHD and highlights the importance of long-term follow-up and further research into underlying mechanisms.

Methods: Forty-three pain-free controls and 43 patients with chronic NSLBP were enrolled. Using non-invasive techniques, synchronized lumbar spine motion and erector spinae (ES) EMG activity were recorded during standardized trunk flexion-extension cycles. Results: Several variables differed significantly between the two groups. Logistic regression identified two variables with significant odds ratios for the presence of chronic NSLBP: time spent with the spine flexed beyond 90% of its maximum range (odds ratio, 0.92; 95% confidence interval, 0.86–0.99) and the ES relaxation ratio (odds ratio, 1.08; 95% confidence interval, 1.04–1.13). Conclusions Individuals with and without chronic NSLBP exhibit distinct spinal motion and ES activity patterns during trunk flexionextension. These differences—specifically the time of maximum lumbar flexion and the relaxation ratio—can be objectively and easily measured. Their assessment may offer valuable clinical utility for the diagnosis and follow-up of NSLBP patients.

Background: and Purpose We aimed to evaluate whether early versus late initiation of direct oral anticoagulant (DOAC) after acute ischemic stroke (AIS) yields different safety and efficacy outcomes in Asian versus non-Asian patients. Methods: We analyzed Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN) trial data from 2,013 AIS patients with atrial fibrillation (AF) randomized to early (≤48 hours for minor/moderate stroke, 6–7 days for major stroke) or late DOAC initiation (3–4 days for minor ischemic stroke, 6–7 days for moderate ischemic stroke, 12–14 days for major ischemic stroke). Patients were categorized by region as Asian (Japan and India) or non-Asian. The primary outcome was a composite of major extracranial bleeding, symptomatic uncerintracranial hemorrhage (SICH), recurrent ischemic stroke, systemic embolism (SE), or vascular death at 30 days (trial registration: ClinicalTrials.gov number, NCT03148457). Results: Among 1,975 patients, 245 were Asian (192 from Japan and 53 from India) and 1,730 were non-Asian. The primary outcome occurred in 6.5% of Asian patients (4.8% early vs. 8.3% late) and 3.1% of non-Asian patients (2.7% vs. 3.6%) (p<0.01). Higher rates of recurrent ischemic stroke (4.1% [2.4% vs. 5.8%] vs. 1.7% [1.3% vs. 2.1%], p=0.02) and SE (2.0% [0.8% vs. 3.3%] vs. 0.5% [0.4% vs. 0.6%], p=0.02) accounted for this difference. No significant differences were observed in major extracranial bleeding, SICH, recurrent ischemic stroke, SE, or vascular death. No significant interaction was observed between region and treatment allocation. Conclusions Although Asian patients had worse baseline profiles and outcomes, treatment effects did not differ by region, supporting the generalizability of early DOAC initiation in Asian AIS patients without region-specific timing modifications.

Objective: We estimated the prevalence of statin intolerance (SI) in a Portuguese primary care population, applying the CLEAR Outcomes trial inclusion criteria. Methods: This retrospective study analyzed electronic health records (EHRs) from the Local Health Unit of Matosinhos, Portugal (from system launch through December 2023).The study included both men and women (postmenopausal, surgically sterile, or using birth control) aged 18–85 years, with a history of atherosclerotic cardiovascular disease (ASCVD) or at high/very-high ASCVD risk, and a low-density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL while receiving lipid-lowering therapies. The index date was defined as the date when each patient met all eligibility criteria. SI (the prescription of ≥2 statins at any dose, or 1 statin at any dose in patients unwilling to try a second statin) was identified through freetext search. Univariate logistic regression analyses were performed. Results: In total, 12,393 patients were eligible for inclusion. SI was observed in 9.6% (n=1,195) of patients, who in December 2023 had a median (1st to 3rd quartiles) age of 73 years (68–78 years) and a median LDL-C of 100 mg/dL (76–129 mg/dL). Most patients were male (55.2%), had ≥3 comorbidities (78.2%), and 42.1% were prescribed a moderateintensity statin. Individuals aged ≥70 years had a higher likelihood of SI (odds ratio [OR], 1.3;95% confidence interval [CI], 1.1–1.4). Women showed a non-significantly higher likelihood of SI (OR, 1.1; 95% CI, 0.9–1.2). Conclusion The prevalence of SI observed in this study is consistent with existing literature and is particularly elevated in older individuals. These findings highlight the need to prioritize alternative therapies for dyslipidemia in this population.

Purpose: To evaluate whether time-series analysis of detrusor pressure during the pressure-flow phase provides diagnostic information that complements conventional urodynamic parameters in the assessment of bladder outlet obstruction (BOO) in men with lower urinary tract dysfunction. Methods: An observational, analytical, cross-sectional study was conducted including men ≥18 years undergoing urodynamic evaluation for voiding dysfunction. Pressure-flow studies were performed according to International Continence Society standards. Detrusor pressure data recorded during voiding were exported at one-second resolution and analyzed as timeseries restricted to the active flow phase. From these segments, descriptive statistical metrics were derived, including mean detrusor pressure during voiding (mPeDet). BOO was classified using conventional indices and final clinical judgment by an experienced urologist, which served as the reference standard. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and Cohen kappa. Results: Forty-one patients were included (median age, 59 years). mPeDet showed a strong correlation with the bladder outlet obstruction index (r=0.89, P<0.001). ROC analysis demonstrated excellent diagnostic performance for mPeDet in identifying BOO, with an area under the curve of 0.95. A cutoff value of 37 cm H₂O yielded a sensitivity of 88% and specificity of 87%. Agreement between mPeDet-based classification and final clinical diagnosis was moderate (κ=0.69). Conclusions Time-series-based evaluation of detrusor pressure during voiding provides additional clinically relevant information compared to conventional point-based urodynamic parameters. mPeDet may serve as a simple and reproducible complementary marker for the assessment of BOO, particularly in cases with diagnostic uncertainty.

BACKGROUND

Spinocerebellar Ataxia (SCA) represents a rare and heterogeneous group of neurodegenerative disorders, typically characterized by the progressive loss of coordination of movement, resulting primarily from cerebellar dysfunction. This case report discusses the history, clinical presentation, and diagnostic findings of a patient who exhibited symptoms suggestive of SCA. Given the notable familial pattern, further evaluation was undertaken using genetic testing. The objective of this paper is to present the clinical, genetic findings, and inheritance pattern of a patient and her family with SCA.

CASE PRESENTATION

Our case is a 36-year-old Filipino female with progressive cerebellar dysfunction for over a decade. Cranial Magnetic Resonance Imaging (MRI) revealed bilateral cerebellar atrophy. Genetic testing identified a Variant of Uncertain Significance (VUS) in the inositol 1,4,5- triphosphate receptor type 1 (ITPR1) gene, a finding consistent with Spinocerebellar Ataxia type 15 (SCA 15). This represents the first reported case of SCA 15 in the Philippines and in Asia.

A detailed pedigree assessment revealed that 18 immediate and extended family members had similar symptoms suggestive of hereditary ataxia. Ten relatives had already passed away, and four could not be contacted for further evaluation. Three available family members were examined and likewise demonstrated comparable cerebellar findings, supporting a familial pattern of the disease.

CONCLUSION

The findings from this case series suggest that SCA 15 may be present in Filipino families, with an autosomal dominant (AD) inheritance pattern. While no data on the prevalence or incidence of SCA15 in the Philippines currently exists, this report calls attention to the need for further research and genetic studies within the Filipino population.

Human ; Female ; Adult: 25-44 Yrs Old ; Spinocerebellar Ataxias ; Ataxia ; Mutation ; Genes ; Asia