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Perswani P, Ismail SM, Mumtaz H, Uddin N, Asfand M, Khalil ABB, Ijlal A, Khan SE, Usman M, Younas H, Rai A. Rethinking HDL-C: An In-Depth Narrative Review of Its Role in Cardiovascular Health. Curr Probl Cardiol 2024; 49:102152. [PMID: 37852560 DOI: 10.1016/j.cpcardiol.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
The interplay between HDL-C and LDL levels are closely intertwined with the cardiovascular system. High-Density Lipoprotein Cholesterol (HDL-C) is a well-known biomarker traditionally being interpreted as higher the HDL-C levels, minimal the risk of adverse cardiovascular disease (CVD) outcomes. However, recent research has unveiled a more complex relationship between HDL-C levels and cardiovascular outcomes, including genetic influences and potential risks associated with extremely high HDL-C levels. Intriguingly, extremely high HDL-C levels have been linked to unexpected cardiovascular risks. Up To date research suggests that individuals with genetically linked ultra-high HDL-C levels may depict an increased susceptibility to CVD, challenging the conventional realm that higher HDL-C is always beneficial. The mechanisms underlying this mystery are not fully understood but may involve HDL particle functionality and composition. In a nutshell, the relationship between HDL-C levels and cardiovascular outcomes is multifactorial. While low HDL-C remains a recognized risk factor for CVD, the genetic determinants of HDL-C levels add complexity to this association. Furthermore, extremely high HDL-C levels may not exhibit the expected protective benefits and may even pose unprecedented cardiovascular risks. A comprehensive understanding of these dynamics is essential for advancing our knowledge of CVD risk assessment and developing targeted therapeutic interventions. Further studies are needed to unravel the intricacies of HDL-C's role in cardiovascular health and disease.
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Affiliation(s)
| | | | - Hassan Mumtaz
- Care Coordinator: Association for Social Development, Islamabad, Pakistan; International Practitioner: Faculty of Public Health UK.
| | - Naseer Uddin
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | | | - Aisha Ijlal
- South City Institute of physical therapy and rehabilitation, Karachi.
| | - Shaheer Ellahi Khan
- Associate Professor of Public Health: Health services Academy, Islamabad, Pakistan; Adjunct Professor: Dala Lana School Of Public Health, University of Toronto, Canada.
| | | | - Hadia Younas
- Services institute of medical Sciences, Lahore, Pakistan.
| | - Anushree Rai
- Govt. Chhattisgarh institute of Medical sciences, Bilaspur, Chhattisgarh, India.
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Fayaz A, Raza M, Khan A, Mohandas P, Getnet Ayalew H, Perswani P, Wei CR, Abdelbaki MA. Comparison of Cardiovascular Outcomes and All-Cause Mortality Between Patients With and Without Epilepsy: A Systematic Review and Meta-Analysis of Observational Studies. Cureus 2024; 16:e54706. [PMID: 38523952 PMCID: PMC10960613 DOI: 10.7759/cureus.54706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
This meta-analysis aimed to assess the all-cause mortality and cardiovascular outcomes among patients diagnosed with epilepsy. The entire process of this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and reporting completeness. A comprehensive search strategy was employed to identify relevant studies in electronic databases, including PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL), from January 1, 2010, to January 15, 2024. Outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and arrhythmias. A total of 12 studies were included in this meta-analysis with a pooled sample size of 7,026,313. The majority of included studies were conducted in Taiwan (n=4). Our study revealed that individuals with epilepsy faced a higher risk of all-cause mortality, cardiovascular mortality, and stroke. Although there was a higher incidence of myocardial infarction and arrhythmias among epilepsy patients, this disparity did not reach statistical significance. There is a need for future research to explore the impact of epilepsy types, antiepileptic drugs, and lifestyle factors on cardiovascular outcomes.
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Affiliation(s)
- Azrung Fayaz
- Internal Medicine, College of Physicians and Surgeons, Peshawar, PAK
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Mehnahil Raza
- Medicine, King Edward Medical University, Lahore, PAK
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
| | | | | | - Prinka Perswani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
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Winicki NM, Desai D, Desai A, Perswani P, Smadi KA, Doyle K, Gandhi H, Sethi PS, Mukherjee A. 'From Gut to Heart': A rare case of Salmonella Typhimurium Bacteremia and native valve endocarditis. IDCases 2023; 32:e01787. [PMID: 37214186 PMCID: PMC10195881 DOI: 10.1016/j.idcr.2023.e01787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Background Salmonella species are very rarely associated with infective endocarditis, accounting for less than 0.01-2.9 % of total bacterial endocarditis cases. Since 1976, there have less than 90 reported cases of non-Typhoidal Salmonella bacteremia and endocarditis. Case presentation We present the case of a 57-year-old homeless man with a past medical history significant only for polysubstance abuse. He presented to the emergency department with a 3-day history of severe, non-bloody diarrhea, nausea, chills, and oliguria. Due to the patient's history of substance use, screening laboratory tests were conducted and were positive for rapid plasma reagin, treponemal antibodies, and hepatitis C. For the profuse diarrhea and severe volume loss, C. difficile, stool white blood cells and stool ova and parasites were ordered but were ultimately negative. Both sets of blood cultures were found to be positive for Salmonella Typhimurium bacteremia. Further workup with transthoracic and transesophageal echocardiogram displayed small mobile masses attached to the aortic surface of the right and non-coronary cusps, confirming endocarditis on the aortic valve. Treatment included penicillin-G once a week for 3 weeks for latent syphilis and ceftriaxone and levofloxacin for bacteremia and endocarditis. Conclusions Patients with Salmonella typically present early with gastrointestinal symptoms, but clinicians should consider cardiovascular imaging if blood cultures are found to be positive in order to potentially identify and promptly treat highly fatal Salmonella endocarditis.
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Affiliation(s)
- Nolan M. Winicki
- University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Prinka Perswani
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Khaled Al Smadi
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Kieran Doyle
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Haresh Gandhi
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Prabhdeep S. Sethi
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Ashis Mukherjee
- Department of Internal Medicine, University of California Riverside, School of Medicine, Riverside, CA, USA
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Patel F, Perswani P, Ansari S, Chitkara A, Desai A, Patel Z, Dhaliwal J, Garg N, Doyle K. APIXABAN INDUCED ANAPHYLACTIC REACTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kumar R, Kumar R, Perswani P, Taimur M, Shah A, Shaukat F. Clinical and Microbiological Profile of Urinary Tract Infections in Diabetic versus Non-Diabetic Individuals. Cureus 2019; 11:e5464. [PMID: 31641561 PMCID: PMC6802799 DOI: 10.7759/cureus.5464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. In most cases, urinary tract infections (UTI) in diabetic patients are asymptomatic. The aim of this study to was to compare the incidence and clinical and microbiological features of UTI between diabetic and non-diabetic patients. Methods In this prospective, comparative study, the incidence and clinical and microbiological features of UTI were compared between diabetic and non-diabetic patients via consecutive non-probability sampling technique. For every diabetic patient, one non-diabetic control was included. All patients were screened for UTI through a midstream urinary sample. Their demographic characteristics, clinical profile, and urinary microscopy were compared. Data were entered and analyzed using SPSS version 22.0. Results In the diabetes group, 35/256 (13.67%) patients had culture-positive UTI as compared to 18/250 (7.2%) in the non-diabetic group. Diabetic group had twice the risk of UTI (p = 0.01; odds ratio [OR]: 2.04; confidence interval [CI]: 1.12, 3.71) and female gender in the diabetic group had a risk of almost five times (p = 0.01; OR: 4.93; CI: 1.12, 20.16) that of the non-diabetic group. In the diabetic group, 31.4% patients were asymptomatic as compared to 5.6% in the non-diabetic group (p = 0.03; OR: 7.79; CI: 0.92, 66.18). E. coli was the most commonly identified microorganism in both groups. Pseudomonas aeruginosa was identified in 14% of diabetic cases and none in the non-diabetic. Conclusions UTIs are more frequent among diabetics. Asymptomatic bacteriuria is a more common entity in diabetic patients and does not require any treatment.
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Affiliation(s)
- Ravi Kumar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Rajesh Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Prinka Perswani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Muhammad Taimur
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ali Shah
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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