BACKGROUND AND OBJECTIVE

Physician adherence to the recommended management of patients with heart failure with reduced ejection fraction (HFrEF) at the outpatient setting is crucial to reduce the burden of subsequent rehospitalization, morbidity, and mortality. Recently updated guidelines recommend early and rapid titration to optimal doses of medications in the first 2 to 6 weeks of discharge. In the absence of local data, our study evaluates physician adherence to guideline-recommended treatment in this setting.

This is a retrospective cross-sectional study among post-discharge HFrEF patients at the outpatient department from December 2022 to May 2023 with a follow-up within three months. Clinical profile and treatment were extracted from medical records. Adherence to the 2021 ESC Guidelines Class I recommendations, among eligible patients, is measured as quality indicators. Data are presented using descriptive statistics.

A total of 99 patients were included in the study. Overall, adherence to prescription of beta-blockers (94.8%), ACEI/ARNI/ARBs (88.5%), and diuretics (100%) were high. Prescription of mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were 67% and 57.3%, respectively. Over three months of follow-up, improvement in the quality of care was demonstrated with ACEI/ARNI/ARBs (81.8% to 90.9%), MRA (68.7 to 81.2%), and SGLT2i (58% to 67.7%). Beta-blocker use is consistently high at 97%. In the 3rd month post-discharge, titration to optimal doses was achieved in only 26.4%, 15%, and 6.25% for those on beta-blockers, ACEI/ARNI/ARB, and MRA, respectively. For non-pharmacologic management, referral to HF specialty was made in 30% and cardiac rehabilitation in 22.2%.

Among patients with HFrEF seen at the outpatient, there is good physician adherence to betablockers, ACEI/ARNI/ARBs, and diuretics. MRA and SGLT2i prescription, referral to HF specialty and cardiac rehabilitation, and up-titration to optimal doses of oral medications for HF need improvement. Hospital pathway development and regular performance evaluation will improve initiation, maintenance, and up-titration of appropriate treatment.

Background and Objective: Physician adherence to the recommended management of patients with heart failure with reduced ejection fraction (HFrEF) at the outpatient setting is crucial to reduce the burden of subsequent rehospitalization, morbidity, and mortality. Recently updated guidelines recommend early and rapid titration to optimal doses of medications in the first 2 to 6 weeks of discharge. In the absence of local data, our study evaluates physician adherence to guideline-recommended treatment in this setting. Methods: This is a retrospective cross-sectional study among post-discharge HFrEF patients at the outpatient department from December 2022 to May 2023 with a follow-up within three months. Clinical profile and treatment were extracted from medical records. Adherence to the 2021 ESC Guidelines Class I recommendations, among eligible patients, is measured as quality indicators. Data are presented using descriptive statistics. Results: A total of 99 patients were included in the study. Overall, adherence to prescription of beta-blockers (94.8%), ACEI/ARNI/ARBs (88.5%), and diuretics (100%) were high. Prescription of mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were 67% and 57.3%, respectively. Over three months of follow-up, improvement in the quality of care was demonstrated with ACEI/ARNI/ARBs (81.8% to 90.9%), MRA (68.7 to 81.2%), and SGLT2i (58% to 67.7%). Beta-blocker use is consistently high at 97%. In the 3rd month post-discharge, titration to optimal doses was achieved in only 26.4%, 15%, and 6.25% for those on beta-blockers, ACEI/ARNI/ARB, and MRA, respectively. For non-pharmacologic management, referral to HF specialty was made in 30% and cardiac rehabilitation in 22.2%. Conclusion Among patients with HFrEF seen at the outpatient, there is good physician adherence to betablockers, ACEI/ARNI/ARBs, and diuretics. MRA and SGLT2i prescription, referral to HF specialty and cardiac rehabilitation, and up-titration to optimal doses of oral medications for HF need improvement. Hospital pathway development and regular performance evaluation will improve initiation, maintenance, and up-titration of appropriate treatment.
Human ; outpatients

Distal medium vessel occlusions (DMVOs) are thought to cause as many as 25% to 40% of all acute ischemic strokes and may result in substantial disability amongst survivors. Although intravenous thrombolysis (IVT) is more effective for distal than proximal vessel occlusions, the overall efficacy of IVT remains limited in DMVO with less than 50% of patients achieving reperfusion and about 1/3 to 1/4 of the patients failing to achieve functional independence. Data regarding mechanical thrombectomy (MT) among these patients remains limited. The smaller, thinner, and more tortuous vessels involved in DMVO are presumably associated with higher procedural risks whereas a lower benefit might be expected given the smaller amount of tissue territory at risk. Recent advances in technology have shown promising results in endovascular treatment of DMVOs with room for future improvement. In this review, we discuss some of the key technical and clinical considerations in DMVO treatment including the anatomical and clinical terminology, diagnostic modalities, the role of IVT and MT, existing technology, and technical challenges as well as the contemporary evidence and future treatment directions.

Cinnamon, a member of the Lauraceae family, has been widely used as a spice and traditional herbal medicine for centuries and has shown beneficial effects in cardiovascular disease, obesity, and diabetes. However, its effectiveness as a therapeutic intervention for chronic kidney disease (CKD) remains unproven. The bioactive compounds within cinnamon, such as cinnamaldehyde, cinnamic acid, and cinnamate, can mitigate oxidative stress, inflammation, hyperglycemia, gut dysbiosis, and dyslipidemia, which are common complications in patients with CKD. In this narrative review, we assess the mechanisms by which cinnamon may alleviate complications observed in CKD and the possible role of this spice as an additional nutritional strategy for this patient group.

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Heart Diseases/epidemiology* ; Humans ; Parkinson Disease/drug therapy* ; Propolis

BACKGROUND: Venous ulcer represents the most advanced stage of chronic venous insufficiency. It is an important public health problem and has a significant impact on patients' quality of life due to chronic pain, inability to work, need for hospitalization and frequent outpatient follow-up. OBJECTIVE: We investigated the treatment benefits of far-infrared ceramic (cFIR), in a 90-day study of lower limb venous ulcers and looked at ulcer healing scores, quality of life, serum bio-markers of oxidative stress and antioxidant defense enzymes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a randomized double-blind placebo-controlled study conducted in the Vascular Surgery Service of a hospital located in the northwest region of the State of Rio Grande do Sul, Brazil. We included patients with lower limb venous ulcers who were randomized to use either a bioceramics wrap or a placebo wrap for 90 days. MAIN OUTCOME MEASURES: The following evaluations were conducted at baseline and after 15, 30, 60 and 90 days: ulcer healing score, quality of life, and serum markers of oxidative stress and antioxidant enzyme activity. RESULTS: Patients (n = 24) with lower limb venous ulcers were randomized into two treatment groups. cFIR decreased the ulcer size on day 30 (P = 0.042) and 90 (P = 0.034) and the total ulcer healing scale scores on day 30 (P = 0.049) and 90 (P = 0.02) of the treatment, when compared to baseline. Additionally, cFIR improved tissue type (epithelial tissue) on day 60 (P = 0.022) when compared to baseline evaluation. CONCLUSION: cFIR clinically improved ulcer healing in patients with lower limb venous ulcers. TRIAL REGISTRATION RBR-8c7xzn on ReBEC.

OBJECTIVE: Although Angelica archangelica is a medicinal and aromatic plant with a long history of use for both medicinal and food purposes, there are no studies regarding the antineoplastic activity of its root. This study aimed to evaluate the cytotoxicity and antitumor effects of the crude extract of A. archangelica root (CEAA) on breast cancer. METHODS: The cytotoxicity of CEAA against breast adenocarcinoma cells (4T1 and MCF-7) was evaluated by a 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. Morphological and biochemical changes were detected by Hoechst 33342/propidium iodide (PI) and annexin V/PI staining. Cytosolic calcium mobilization was evaluated in cells staining with FURA-4NW. Immunoblotting was used to determine the effect of CEAA on anti- and pro-apoptotic proteins (Bcl-2 and Bax, respectively). The 4T1 cell-challenged mice were used for in vivo assay. RESULTS: Using ultra-high-performance liquid chromatography-mass spectrometry analysis, angelicin, a constituent of the roots and leaves of A. archangelica, was found to be the major constituent of the CEAA evaluated in this study (73 µg/mL). The CEAA was cytotoxic for both breast cancer cell lines studied but not for human fibroblasts. Treatment of 4T1 cells with the CEAA increased Bax protein levels accompanied by decreased Bcl-2 expression, in the presence of cleaved caspase-3 and cytosolic calcium mobilization, suggesting mitochondrial involvement in breast cancer cell death induced by the CEAA in this cell line. No changes on the Bcl-2/Bax ratio were observed in CEAA-treated MCF7 cells. Gavage administration of the CEAA (500 mg/kg) to 4T1 cell-challenged mice significantly decreased tumor growth when compared with untreated animals. CONCLUSION Altogether, our data show the antitumor potential of the CEAA against breast cancer cells in vitro and in vivo. Further research is necessary to better elucidate the pharmacological application of the CEAA in breast cancer therapy.

Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-oflife, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.