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Oley MH, Oley MC, Langi FLFG, Flapper W, Islam AA, Hatta M, Laidding SR, Limarga N, Faruk M. Serum BMP-2 and osteocalcin levels, and CT Hounsfield unit post hyperbaric oxygen therapy in patients with cleft lip and palate post alveolar bone graft: A case study. Heliyon 2023; 9:e19955. [PMID: 37809437 PMCID: PMC10559552 DOI: 10.1016/j.heliyon.2023.e19955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background This study investigated the levels of bone morphogenetic protein 2 (BMP-2), osteocalcin, and 3D CT Hounsfield units following hyperbaric oxygen therapy (HBOT) in patients with cleft lip and palate (CLP) undergoing alveolar bone grafts to provide a pilot evaluation of the role of HBOT in osteogenesis. Methods This prospective, quasi-experimental, pre-post-intervention study evaluated seven patients with CLP receiving HBOT after single-stage reconstructions with alveolar bone grafts. The outcomes included the serum levels of BMP-2 and osteocalcin and the 3D CT Hounsfield units obtained before and after the surgery, and after the five HBOT sessions, to a total of 12 measurements. The data were analyzed with linear mixed-effects models using the intervention stage (pre-surgery, pre-HBOT, first to fifth HBOT sessions) as covariates and adjusting for several baseline factors. Results A significant difference was found in outcome measures across time (ANOVA p < 0.001 for BMP-2 and osteocalcin, p = 0.01 for Hounsfield units), with mean values appearing to steadily increase once HBOT began. Regression analyses indicated that the effect of HBOT was evident in serum osteocalcin after the 1st HBOT session (adjusted b = 1.32; 95% CI 0.39, 2.25) and in serum BMP-2 after the third session (adjusted b = 6.61; 95% CI 1.93, 11.28). After the fifth session, the HBOT effect was fairly pronounced on the two outcomes: the adjusted increase compared to the baseline was 28.06 ng/mL for BMP-2 and 6.27 ng/mL for osteocalcin. Our mixed-effect models also showed a post-HBOT increase in Hounsfield units. Conclusion We found an increase of BMP-2, osteocalcin, and Hounsfield units following the HBOT intervention. These may suggest an effect of HBOT on osteogenesis.
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Affiliation(s)
- Mendy Hatibie Oley
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia
- Hyperbaric Centre Siloam Hospital, Manado, Indonesia
| | - Maximillian Christian Oley
- Hyperbaric Centre Siloam Hospital, Manado, Indonesia
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
- Division of Neurosurgery, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia
| | - Fima Lanra Fredrik G. Langi
- Department Epidemiology and Biostatistics, Public Health Faculty, Sam Ratulangi University, Manado, Indonesia
| | - Walter Flapper
- Cleft and Craniofacial South Australia, University of Adelaide, Australia
| | - Andi Asadul Islam
- Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Mochammad Hatta
- Department of Clinical Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Sachraswaty R. Laidding
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nidia Limarga
- Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Institute for Research and Community Services, Hasanuddin University, Makassar, Indonesia
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Abstract
Background We hypothesized that stroke outcome is related to multiple baseline hydration-related factors including volume contracted state (VCS) and diuretic use. Methods and Results We analyzed a prospective cohort of subjects with ischemic stroke <24 hours of onset enrolled in acute treatment trials within VISTA (Virtual International Stroke Trials Archive). A VCS was defined based on blood urea nitrogen-to-creatinine ratio. The primary end point was modified Rankin Scale score at 90 days. Primary analysis used generalized ordinal logistic regression over the mRS range, adjusted for Totaled Health Risks in Vascular Events score, onset-to-enrollment time, and thrombolytic use. Of 5971 eligible patients with stroke, 42% were taking diuretics at the time of hospitalization, and 44% were in a VCS. Patients in a VCS were older, had more vascular risk factors, were more likely taking diuretics, and had more severe strokes. Diuretic use was associated with both reduced chance of achieving a good functional outcome (odds ratio [OR], 0.57 [95% CI, 0.52-0.63]) and increased mortality at 90 days (OR, 2.30 [95% CI, 2.04-2.61]). VCS was associated with greater mortality 90 days after stroke (OR, 1.53 [95% CI, 1.33-1.76]). There was no evidence of effect modification among the 3 exposures of VCS, diuretic use, or hypokalemia in relation to outcome. Conclusions A VCS at the time of hospitalization was associated with more severe stroke and odds of death but not associated with worse functional outcome when accounting for relevant characteristics. Diuretic use and low serum potassium at the time of stroke onset were associated with worse outcome and may be worthy of further investigation.
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Affiliation(s)
| | | | - Philip M. Bath
- Stroke Trials Unit, University of NottinghamNottinghamUnited Kingdom
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Functional status improves in hypertensive older adults: the long-term effects of antihypertensive therapy combined with multicomponent exercise intervention. Aging Clin Exp Res 2018; 30:1483-1495. [PMID: 29512042 DOI: 10.1007/s40520-018-0925-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The increasing prevalence of functionally-limited hypertensive individuals highlights the need for interventions to reduce the burden of hypertension-aging-disability and to maximize the chances of healthy aging. AIM This study aims to compare the effects of multicomponent exercise and different pharmacological treatments on functional status and cardiovascular risk outcomes in hypertensive older adults with comorbidities. METHODS Participants (n = 96) engage in a 3 days/week multicomponent (aerobic + resistance) exercise program and for one of the following three conditions: (1) thiazide-related diuretics (TDs; n = 33, 69.9 ± 9.5 years); (2) calcium channel blockers (CCBs; n = 23, 67.0 ± 9.0 years); (3) and β-blockers (βBs; n = 40, 65.6 ± 7.2 years) medication. Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, anthropometrics and hemodynamic profile, health-related quality of life (HRQoL; Short-Form Health Survey 36) and health history questionnaires. RESULTS All groups have significantly improved the physical functional status; particularly upper and lower body strength and aerobic endurance and systolic blood pressure. The TDs and βBs groups have diminished the waist circumference and body mass. The CCBs decreased total cholesterol (P = 0.028), perceived better physical functioning, physical component score but also augmented bodily pain (P < 0.05). The βB group decreased triglycerides (P = 0.013). No group differences were found. CONCLUSION Multicomponent exercise training has improved functional status regardless of the antihypertensive medication options. Hypertensive older adults should add exercise training to pharmacological antihypertensive therapy to reduce the rate of physical disability.
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Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, Lavados PM, Gandhi DBC, Thrift AG. Prevention of stroke: a global perspective. Lancet 2018; 392:1269-1278. [PMID: 30319114 DOI: 10.1016/s0140-6736(18)31269-8] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022]
Abstract
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India.
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mahesh P Kate
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Gisele S Silva
- Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce I Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pablo M Lavados
- Vascular Neurology Unit, Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Dorcas B C Gandhi
- College of Physiotherapy, Christian Medical College and Hospital Ludhiana, Ludhiana, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Baptista LC, Amorim AP, Valente-Dos-Santos J, Machado-Rodrigues AM, Veríssimo MT, Martins RA. Antihypertensive monotherapy or combined therapy: which is more effective on functional status? Clin Exp Hypertens 2018; 40:686-694. [PMID: 29336626 DOI: 10.1080/10641963.2018.1425419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aims to analyze the effects of anti-hypertensive monotherapy and combined therapy on functional status, and cardiovascular risk outcomes in older adults. METHODS This longitudinal non-randomized cohort study, involved hypertensive older adults (n = 440) aged 60 or more years with comorbidities. Participants underwent a community exercise training program and one of the following 2 conditions: i) use of daily mono-dose angiotensin-converting enzyme inhibitors (ACEi; n= 232); ii) combined therapy including ACEi plus other class agent (Combined; n= 208). Baseline and 2-year follow-up evaluations included the functional fitness, health-related quality of life (HRQoL), health history questionnaires, anthropometric and hemodynamic profile. RESULTS Both experimental groups have significantly improved physical functional status, and have significantly decreased blood pressure and waist circumference. ACEi group has significantly reduced body mass and body mass index, the Combined group significantly reduced the waist-to-hip ratio. Additionally, both groups perceived better physical HRQoL. CONCLUSIONS Functional status has improved with ACEi medication and exercise training, regardless the ACEi medication therapy. Exercise training plus ACEi antihypertensive therapy should be recommended into the standard prescription practice to reduce the rate of physical disability among hypertensive older adults.
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Affiliation(s)
- Liliana C Baptista
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
| | - André Pinto Amorim
- b Departamento de Ciências do Desporto , Universidade da Beira Interior , Covilhã , Portugal
| | - João Valente-Dos-Santos
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal.,d Fundação Portuguesa para a Ciência e Tecnologia (SFRH/BPD/100470/2014) , Lisboa , Portugal.,e Institute for Biomedical Imaging and Life Sciences (IBILI), Faculdade de Medicina , Universidade de Coimbra , Coimbra , Portugal.,f Faculdade de Educação Física e Desporto , Universidade Lusófona , Lisboa , Portugal
| | | | | | - Raul A Martins
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
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Pandian JD, William AG, Kate MP, Norrving B, Mensah GA, Davis S, Roth GA, Thrift AG, Kengne AP, Kissela BM, Yu C, Kim D, Rojas-Rueda D, Tirschwell DL, Abd-Allah F, Gankpé F, deVeber G, Hankey GJ, Jonas JB, Sheth KN, Dokova K, Mehndiratta MM, Geleijnse JM, Giroud M, Bejot Y, Sacco R, Sahathevan R, Hamadeh RR, Gillum R, Westerman R, Akinyemi RO, Barker-Collo S, Truelsen T, Caso V, Rajagopalan V, Venketasubramanian N, Vlassovi VV, Feigin VL. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review. Neuroepidemiology 2017; 49:45-61. [DOI: 10.1159/000479518] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023] Open
Abstract
Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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Villa RF, Ferrari F, Moretti A. Effects of Neuroprotectants Before and After Stroke: Statins and Anti-hypertensives. SPRINGER SERIES IN TRANSLATIONAL STROKE RESEARCH 2017. [DOI: 10.1007/978-3-319-45345-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wijkman M. Diuretics and Cerebrovascular Outcomes--Beyond Traditional Endpoints. J Clin Hypertens (Greenwich) 2015; 17:273-4. [DOI: 10.1111/jch.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Magnus Wijkman
- Department of Internal Medicine and Department of Medical and Health Sciences; Linköping University; Norrköping Sweden
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