Predictors of non-obstructive coronary slow flow in poorly controlled type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Coronary slow flow (CSF) can occur due to various factors, such as inflammation, small vessel disease, endothelial dysfunction, and inadequate glucose control. However, the exact pathological mechanisms behind CSF remain incompletely understood. The objective of this study was to identify the risk factors associated with slow coronary flow in individuals with Type 2 Diabetes Mellitus (T2DM) who have non-obstructive coronary artery disease (CAD) and experience CSF. METHODS: We conducted a prospective cohort study involving 120 patients with T2DM who were referred for invasive coronary angiography due to typical chest pain or inconclusive results from non-invasive tests for myocardial ischemia. Using a 2 × 2 design, we categorized patients into groups based on their glycemic control (adequate or poor) and the presence of CSF (yes or no), defined by a TIMI frame count > 27. All patients had non-obstructive CAD, characterized by diameter stenosis of less than 40%. We identified many variables associated with CSF. RESULTS: Our investigation revealed no significant differences in age, sex, family history of coronary artery disease, ECG ischemia abnormalities, or echocardiographic (ECHO) data between the groups. In patients with adequate glycemic control, hypertension increased the risk of CSF by 5.33 times, smoking by 3.2 times, while dyslipidemia decreased the risk by 0.142. Additionally, hematocrit increased the risk by 2.3, and the platelet-to-lymphocyte ratio (PLR) increased the risk by 1.053. Among patients with poor glycemic control, hematocrit increased the risk by 2.63, and the Neutrophil-to-Lymphocyte Ratio (NLR) by 24.6. Notably, NLR was positively correlated with glycemic control parameters in T2DM patients with CSF. CONCLUSIONS: In T2DM patients with CSF, various factors strongly correlate with glycemic control parameters and can be employed to predict the likelihood of CSF. These factors encompass hypertension, smoking, increased body mass index (BMI), elevated platelet count, hematocrit, NLR, PLR, and C-reactive protein (CRP). TRIAL REGISTRATION: Registry: ZU-IRB (ZU-IRB#9419-3-4-2022), Registered on: 3 April 2022, Email: IRB_123@medicine.zu.edu.eg.

Unleashing the potential of vanillic acid: A new twist on nature's recipe to fight inflammation and circumvent azole-resistant fungal infections.

Vanillic acid (VA) - a naturally occurring phenolic compound in plants - is not only used as a flavoring agent but also a prominent metabolite post tea consumption. VA and its associated compounds are believed to play a significant role in preventing diseases, underscoring the need for a systematic investigation. Herein, we report a 4-step synthesis employing the classical organic reactions, such as Willamson's alkylation, Fischer-Spier reaction, and Steglich esterification, complemented with a protection-deprotection strategy to prepare 46 VA derivatives across the five series (1a-1i, 2a-2i, 3, 3a-3i, 4a-4i, 5a-5i) in high yields. The synthesized compounds were investigated for their antifungal, anti-inflammatory, and toxic effects. Notably, compound 1a demonstrated remarkable ROS inhibition with an IC50 value of 5.1 ± 0.7 µg/mL, which is more than twice as effective as the standard ibuprofen drug. A subset of the synthesized derivatives (2b, 2c, 2e, 3b-3d, 4a-4c, 5a, and 5e) manifested their antifungal effect against drug-resistant Candida strains. Compound 5g, in particular, revealed synergism with the established antifungal drugs amphotericin B (AMB) and fluconazole (FLZ), doubling FLZ's potency against azole resistant Candida albican ATCC 36082. Furthermore, 5g improved the potency of these antifungals against FLZ-sensitive strains, including C. glabrata ATCC 2001 and C. parapsilosis ATCC 22019, as well as various multidrug-resistant (MDR) Candida strains, namely C. albicans ATCC 14053, C. albicans CL1, and C. krusei SH2L OM341600. Additionally, pharmacodynamics of compound 5g was examined using time-kill assay, and a benign safety profile was observed with no hemolytic activity in whole blood, and no cytotoxicity towards the normal BJ human cell line. The synergistic potential of 5g was further investigated through both experimental methods and docking simulations.These findings highlight the therapeutic potential of VA derivatives, particularly in addressing inflammation and circumventing FLZ resistance in Candida albicans.

Geochemical processes, salinity sources and utility characterization of groundwater in a semi-arid region of Iraq through geostatistical and isotopic techniques.

Identifying factors contributing to water salinity is paramount in efficiently managing limited water resources in arid environments. The primary objective of this study is to enhance understanding regarding the hydrochemistry, source, and mechanism of water salinity, as well as to assess the suitability of water for various uses in southern Iraq. The groundwater samples were collected from water wells and springs and analyzed for major cations and anions along with stable isotopes (δ18O and δ2H) to accomplish the objective. The analysis of major ion chemistry, hydrochemical techniques, principal component analysis (PCA), and isotope signatures were adopted to determine the primary factors contributing to water mineralization. The study inferred that evaporation and geological processes encompassing water-rock interactions, such as dissolution precipitation and ion exchange, were key processes. The stable isotope analysis revealed that the water originated from meteoric sources and underwent significant evaporation during or before infiltration. The utility assessment of water samples indicates that most samples are not appropriate for consumption and are significantly below the established standards for potable water. In contrast, a significant portion of the groundwater samples were found to meet the criteria for irrigation suitability by adopting Wilcox and the US Salinity Laboratory criteria. The groundwater could be considered for irrigation with proper salinity control management. Overall, this study has significantly improved the understanding of the hydrogeochemical regimes and acts as a first step toward the sustainable utilization of water resources.

Response Surface Methodology (RSM) approach to formulate and optimize the bilayer combination tablet of Tamsulosin and Finasteride.

An orally administered bilayer tablet with Tamsulosin (TAM) as the sustained release (SR) and Finasteride (FIN) as immediate release (IR) was manufactured. A response surface methodology was employed to formulate bilayer tablets with individual release layers, i.e., sustained and immediate release (SR and IR). Independent variables selected in both cases comprise hydroxypropyl methylcellulose (HPMC) as SR polymer, and avicel PH102 in the inner layer while Triacetin and talc in the outer layer, respectively. Tablets were prepared by direct compression, a total of 11 formulations were prepared for inner layer TAM, and 9 formulations for outer layer FIN were designed; these formulations were evaluated for hardness, friability, thickness, %drug content, and %drug release. A central composite design was employed in response surface methodology to design and optimize the formulation. The percentage of drug released was evaluated by in-vitro USP dissolution method of optimized formulation for 0.5, 2, and 6 hrs, and results were 24.63, 52.96, and 97.68 %, respectively. Drug release data was plotted in various kinetic models using a D.D solver, where drug release was first order that is concentration dependent and was best explained by Korsmeyer-Peppa kinetics, as the highest linearity was observed (R2 = 0.9693). However, a very close relationship was also noted with Higuchi kinetics (R2 = 0.9358). The mechanism of drug release was determined through the Korsmeyer model, and exponent "n" was found to be 0.4, indicative of an anomalous diffusion mechanism or diffusion coupled with erosion.

A Statistical Approach for the Integration of Multi-Temporal InSAR and GNSS-PPP Ground Deformation Measurements.

Determining and monitoring ground deformations is critical for hazard management studies, especially in megacities, and these studies might help prevent future disaster conditions and save many lives. In recent years, the Golden Horn, located in the southeast of the European part of Istanbul within a UNESCO-protected region, has experienced significant changes and regional deformations linked to rapid population growth, infrastructure work, and tramway construction. In this study, we used Interferometric Synthetic Aperture Radar (InSAR) and Global Navigation Satellite System (GNSS) techniques to investigate the ground deformations along the Golden Horn coastlines. The investigated periods are between 2015 and 2020 and 2017 and 2020 for InSAR and GNSS, respectively. For the InSAR analyses, we used sequences of multi-temporal synthetic aperture radar (SAR) images collected by the Sentinel-1 and ALOS-2 satellites. The ground displacement products (i.e., time series and velocity maps) were then cross-compared with those achievable using the Precise Point Positioning (PPP) technique for the GNSS solutions, which can provide precise positions with a single receiver. In the proposed analysis, we compared the ground displacement velocities obtained by both methods by computing the standard deviations of the difference between the relevant observations considering a weighted least square estimation procedure. Additionally, we identified five circle buffers with different radii ranging between 50 m and 250 m for selecting the most appropriate coherent points to conduct the cross-comparison analysis. Moreover, a vertical displacement rate map was produced. The comparison of the vertical ground velocities derived from PPP and InSAR demonstrates that the PPP technique is valuable. For the coherent stations, the vertical displacement rates vary between -4.86 mm/yr and -23.58 mm/yr and -9.50 and -27.77 mm/yr for InSAR and GNSS, respectively.

Clinical performance of custom-milled polyetherketoneketone (PEKK) posts and cores: A 12-month follow-up randomized controlled pilot study.

OBJECTIVES: Comparing the survival rate and the cumulative success rates of custom-milled polyetherketone ketone posts and cores (MPP) with prefabricated fiber posts (PFP) in restoring compromised endodontically treated premolars. MATERIAL AND METHODS: This was a randomized, double-blind, parallel, two-arm controlled pilot study. A total of 24 patients (12 males, 12 females), each had a compromised lower premolar, needed a root canal treatment and to be restored with post and core. Patients were randomly allocated into two groups, MPP-group: restored with MPP, and PFP-group: restored with PFP and composite cores. After that, premolars were restored with single porcelain fused to metal (PFM) crowns. Clinical and radiographic follow-ups were conducted after 3, 6, and 12 months. The Kaplan-Meier, log-Rank, and χ2 tests were used to investigate differences between the two groups at the 0.05 significance level. RESULTS: The survival rate after 12 months in the MPP and PFP groups was 66.7% and 100%, respectively. Meanwhile, the cumulative success rates were 63.6% and 100% in the same order. The log-rank test showed a significant difference between the two groups (p = .031). The difference in cumulative success rates was also significant, as the χ2 test revealed (p = .011). CONCLUSION: The PFP group showed a higher success rate than the MPP group and according to the failure types, PEKK posts seem to be inferior to PFP in terms of the mechanical properties and bonding to resin mechanism. TRIAL REGISTRATION: ISRCTN, ISRCTN13456471. October, 14, 2019. (https://doi.org/10.1186/ISRCTN13456471ISRCTN13456471).

Type 2 Diabetes Mellitus Patients' Knowledge About Disease Complications and Management Targets for Glucose, Lipids, Blood Pressure, and Body Weight.

Background As a result of the chronic nature of type 2 diabetes mellitus (T2DM), its complications, and treatment complexity, patients should have a comprehensive knowledge of various aspects of T2DM management and follow-up. The study aimed to assess T2DM patients' knowledge of disease complications and their screening strategies and the management targets for glucose, lipids, blood pressure, and body weight. Methods This was a cross-sectional and questionnaire-based study including 205 adult patients with T2DM from November 2023 to March 2024. The patients were randomly selected at one tertiary endocrine center and the outpatient clinics of three teaching hospitals in Basrah, southern Iraq. Social and disease-related data were collected. Another 18 T2DM-related questions were designed to assess the patients' knowledge about the aim of treatment; T2DM complications and their screening; the recommended targets for glycemic, lipid, and blood pressure control; and the recommended exercise and weight loss. We gave one point for each correct answer and considered a final score of 10/18 as adequate.  Results Of a total of 205 patients, 109 (53.2) were women. The mean age for patients was 48.7 ± 13.1 years. Based on the patients' responses, 107 (52.2%) had adequate knowledge about T2DM. Questions about the target fasting and post-prandial capillary blood glucose, HbA1c target and frequency, and naming the current treatment were the most correctly answered questions (80.9%, 73.1%, 68.7%, and 72.6%, respectively). Questions about the lipid target, definition of hypoglycemia, and ideal lifestyle for T2DM (exercise and bodyweight loss) were least correctly answered. Patients younger than 40 years old, being a man, with a higher educational level, and T2DM duration of more than five years had significantly higher T2DM knowledge. Conclusions Only half of the patients had adequate T2DM knowledge. Better degree of knowledge was particularly observed in patients with younger age, male gender, higher educational level, and longer T2DM duration. There is a need to promote diabetes education strategies for people with T2DM.

Formulation of Phytosomes Containing Rubia cordifolia Extract for Neuropathic Pain: In Vitro and In Vivo Evaluation.

This study aimed to develop a delivery system for the dried aqueous extract of Rubia cordifolia leaves (RCE) that could improve the neuroprotective potential of RCE by improving the bioavailability of the chief chemical constituent rubiadin. Rubiadin, an anthraquinone chemically, is a biomarker phytoconstituent of RCE. Rubiadin is reported to have strong antioxidant and neuroprotective activity but demonstrates poor bioavailability. In order to resolve the problem related to bioavailability, RCE and phospholipids were reacted in disparate ratios of 1:1, 1:2, and 1:3 to prepare phytosome formulations PC1, PC2, and PC3, respectively. The formulation PC2 showed particle size of 289.1 ± 0.21 nm, ζ potential of -6.92 ± 0.10 mV, entrapment efficiency of 72.12%, and in vitro release of rubiadin of 89.42% at pH 7.4 for a period up to 48 h. The oral bioavailability and neuroprotective potential of PC2 and RCE were assessed to evaluate the benefit of PC2 formulation over the crude extract RCE. Formulation PC2 showed a relative bioavailability of 134.14% with a higher neuroprotective potential and significantly (p < 0.05) augmented the nociceptive threshold against neuropathic pain induced by partial sciatic nerve ligation method. Antioxidant enzyme levels and histopathological studies of the sciatic nerves in various treatment groups significantly divulged that PC2 has enough potential to reverse the damaged nerves into a normal state. Finally, it was concluded that encapsulated RCE as a phytosome is a potential carrier system for enhancing the delivery of RCE for the efficient treatment of neuropathic pain.

Analyzing solitary wave solutions of the nonlinear Murray equation for blood flow in vessels with non-uniform wall properties.

Solitary wave solutions are of great interest to bio-mathematicians and other scientists because they provide a basic description of nonlinear phenomena with many practical applications. They provide a strong foundation for the development of novel biological and medical models and therapies because of their remarkable behavior and persistence. They have the potential to improve our comprehension of intricate biological systems and help us create novel therapeutic approaches, which is something that researchers are actively investigating. In this study, solitary wave solutions of the nonlinear Murray equation will be discovered using a modified extended direct algebraic method. These solutions represent a uniform variation in blood vessel shape and diameter that can be used to stimulate blood flow in patients with cardiovascular disease. These solutions are newly in the literature, and give researchers an important tool for grasping complex biological systems. To see how the solitary wave solutions behave, graphs are displayed using Matlab.

Minimally Invasive Surgery through Right Mini-Thoracotomy for Mitral Valve Infective Endocarditis: Contraindicated or Safely Possible?

Background: Mitral valve infective endocarditis (IE) still has a high mortality. Minimally invasive mitral valve surgery (MIMVS) is technically more challenging, especially in patients with endocarditis. Here, we compare the early postoperative outcome of patients with endocarditis and other indications for MIMVS. Methods: Two groups were formed, one consisting of patients who underwent surgery because of mitral valve endocarditis (IE group: n = 75) and the other group consisting of patients who had another indication for MIMVS (non-IE group: n = 862). Patients were observed for 30 postoperative days. Data were retrospectively reviewed and collected from January 2011 to September 2023. Results: Patients from the IE group were younger (60 vs. 68 years; p < 0.001) and had a higher preoperative history of stroke (26% vs. 6%; p < 0.001) with neurological symptoms (26% vs. 9%; p < 0.001). No difference was seen in overall surgery time (211 vs. 206 min; p = 0.71), time on cardiopulmonary bypass (137 vs. 137 min; p = 0.42) and aortic clamping time (76 vs. 78 min; p = 0.42). Concerning postoperative data, the IE group had a higher requirement of erythrocyte transfusion (2 vs. 0; p = 0.041). But no difference was seen in the need for a mitral valve redo procedure, bleeding, postoperative stroke, cerebral bleeding, new-onset dialysis, overall intubation time, sepsis, pacemaker implantation, wound healing disorders and 30-day mortality. Conclusions: Minimally invasive mitral valve surgery in patients with mitral valve endocarditis is feasible and safe. Infective endocarditis should not be considered as a contraindication for MIMVS.

Evaluating the efficacy and safety of platelet-rich plasma injection for erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Platelet-rich plasma (PRP) is rich in factors that play a role in stem cell recruitment, inflammation modulation, and angiogenesis. With numerous preclinical and clinical studies exploring PRP as a potential treatment for erectile dysfunction (ED), this study focused on assessing the effectiveness of intracorporeal PRP injection for ED patients based on randomized controlled trials (RCTs). OBJECTIVES: The study sought to evaluate the efficacy and safety of intracorporeal injection of PRP in treating ED through a systematic review and meta-analysis of RCTs. METHODS: This study adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search was conducted on online databases (PubMed, Scopus, and ScienceDirect) to identify RCTs comparing PRP with a placebo for ED treatment. The primary outcomes assessed were the proportion of patients achieving the minimal clinically important difference in the International Index of Erectile Function (IIEF) domain and the change in the IIEF domain from baseline. The results were combined as a standardized mean difference between the PRP and placebo groups. RESULTS: Three RCTs comprising 230 patients were included. The overall effect favored PRP over placebo: total patients attaining minimal clinically important difference in the IIEF domain (odds ratio [OR], 5.64; 95% confidence interval [CI], 2.05 to 15.55; P = .0008), IIEF change from baseline (mean difference [MD], 2.99; 95% CI, 1.74 to 4.24; P = .00001), PSV (MD, 9.34; 95% CI, 0.84 to 17.84; P = .03), end-diastolic volume (standardized MD, 0.50; 95% CI, 0.17 to 0.83; P = .003), Sexual Encounter Profile question 3 (standardized MD, 0.78; 95% CI, 0.45 to 1.12; P = .00001), and visual analog scale score (MD, -0.30; 95% CI, -0.53 to -0.08; P = .008). CONCLUSION: PRP appears to be a safe and effective treatment for mild-to-moderate ED. However, further support from high-quality RCTs is needed to strengthen these findings.

Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience.

Background: Coronary artery disease is a major cause of death globally. Minimally invasive direct coronary artery bypass (MIDCAB), using a small left anterior thoracotomy, aims to provide a less invasive alternative to traditional procedures, potentially improving patient outcomes with reduced recovery times. Methods: This retrospective, non-randomized study analyzed 310 patients who underwent MIDCAB between July 1999 and April 2022. Data were collected on demographics, clinical characteristics, operative and postoperative outcomes, and follow-up mortality and morbidity. Statistical analysis was conducted using IBM SPSS, with survival curves generated via the Kaplan-Meier method. Results: The cohort had a mean age of 63.3 ± 10.9 years, with 30.6% females. The majority of surgeries were elective (76.1%), with an average operating time of 129.7 ± 35.3 min. The median rate of intraoperative blood transfusions was 0.0 (CI 0.0-2.0) Units. The mean in-hospital stay was 8.7 ± 5.5 days, and the median ICU stay was just one day. Early postoperative complications were minimal, with a 0.64% in-hospital mortality rate. The 6-month and 1-year mortalities were 0.97%, with a 10-year survival rate of 94.3%. There were two cases of perioperative myocardial infarction and no instances of stroke or new onset dialysis. Conclusions: The MIDCAB approach demonstrates significant benefits in terms of patient recovery and long-term outcomes, offering a viable and effective alternative for patients suitable for less invasive procedures. Our results suggest that MIDCAB is a safe option with favorable survival rates, justifying its consideration in high-volume centers focused on minimally invasive techniques.

Hypothermic Ventricular Fibrillation in Redo Minimally Invasive Mitral Valve Surgery: A Promising Solution for a Surgical Challenge.

Background: Minimally invasive mitral valve surgery (MIMVS) is a treatment for severe mitral valve pathologies. In redo cases, especially after coronary artery bypass grafting (CABG) surgery with patent mammary bypass grafts, establishing aortic clamping followed by antegrade cardioplegia application might be challenging. Here, we present the outcome of hypothermic ventricular fibrillation as an alternative to conventional cardioprotection. Methods: Patients who underwent MIMVS either received hypothermic ventricular fibrillation (study group, n = 48) or antegrade cardioprotection (control group, n = 840) and were observed for 30 postoperative days. Data were retrospectively analyzed and collected from January 2011 until December 2022. Results: Patients in the study group had a higher preoperative prevalence of renal insufficiency (p = 0.001), extracardiac arteriopathy (p = 0.001), insulin-dependent diabetes mellitus (p = 0.001) and chronic lung disease (p = 0.036). Furthermore, they had a longer surgery time and a lower repair rate (p < 0.001). No difference, however, was seen in postoperative incidences of stroke (p = 0.26), myocardial infarction (p = 1) and mitral valve re-operation (p = 1) as well as 30-day mortality (p = 0.1) and postoperative mitral valve insufficiency or stenosis. Conclusions: The patients who underwent redo MIMVS with hypothermic ventricular fibrillation did not have worse outcomes or more serious adverse events compared to the patients who received routine conventional cardioprotection. Therefore, the use of hypothermic ventricular fibrillation appears to be a promising cardioprotective technique in this challenging patient population requiring redo MIMVS.

Impacto en la calidad de vida por la comprensión del tinnitus / The Quality of Life impaction by Tinnitus Comprehension

El tinnitus es la sensación de sonido en ausencia de cualquier fuente externa. Nuestro objetivo fue evaluar la repercusión del tinnitus en la calidad de vida. Se inscribieron 25 pacientes con tinnitus con una amplia gama de umbrales de pérdida auditiva (HLT) y estado de gravedad de tinnitus. La gravedad, la ansiedad y la depresión del tinnitus se evaluaron mediante el inventario de discapacidades por tinnitus (THI), el índice funcional de tinnitus (TFI) y la escala de ansiedad y depresión hospitalaria (HADS), respectivamente. Se realizó una audiometría de conducción aérea de tono puro. El impacto de la percepción del tinnitus en la calidad de vida se encontró más alto en el grupo de sufrimiento. La escala de ansiedad y depresión figuraba en 40% y 60%, respectivamente. El uso de la mano fue de 20 diestros y 5 zurdos. El tinnitus bilateral se está experimentando en el 76%. El LH se presentó en 17 (68%) de los pacientes con tinnitus. La descripción del sonido del tinnitus como silbido (40%), siseo (24%), pulsante (16%), timbre (8%) y ruidos de tono alto (12%). Con respecto al cuestionario THI, los sujetos con tinnitus se dividen en 60% (leve), 30% (moderado) y 10% (grave). Mientras que el cuestionario TFI, el 50% mostró un (leve), el 25% (moderado) y el 25% mostró (severo). Postulamos una fuerte asociación positiva significativa entre HADS y la gravedad del tinnitus: THI (P = 0,000) y TFI (P = 0,001). Esos datos revelaron que la percepción del tinnitus tiene impactos negativos en la calidad de vida mientras que la gravedad puede verse alterada por la lateralidad

Tinnitus is the sensation of sound in the absence of any external source, and the aim is to assess the impaction of tinnitus on QoL. 25-tinnitus sufferers were enrolled with a wide range of hearing loss thresholds (HLT) and tinnitus severity status. Tinnitus severity, anxiety and depression were assessed using tinnitus handicap inventory (THI), tinnitus functional index (TFI), and the hospital anxiety and depression scale (HADS), respectively. Pure tone air conduction audiometry was performed. The impaction of tinnitus perception on QoL was found higher in suffering group. The anxiety and depression scale figured in 40%, and 60%, respectively. The handed use was 20 rights handed and 5 left-handed. Bilateral tinnitus is experiencing in 76%. The HL occurred in 17(68%) of tinnitus patients. The description of tinnitus sound as whistling (40%), hissing (24%), pulsating (16%), ringing (8%), and high pitch noises (12%). Regarding THI questionnaire, tinnitus subjects are divided to 60% (mild), 30% (moderate), and 10% (severe). While TFI questionnaire, 50% showed a (mild), 25% (moderate), and 25% showed (severe). We postulated a strong significant positive association between HADS and tinnitus severity: THI (P=0.000) and TFI (P= 0.001). Those data revealed that tinnitus perception has negative impacts on QoL, and the severity may be altered by laterality.

Phenotypic and metabolic dichotomy in obesity: clinical, biochemical and immunological correlates of metabolically divergent obese phenotypes in healthy South Asian adults

<p><b>INTRODUCTION</b>Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.</p><p><b>METHODS</b>Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.</p><p><b>RESULTS</b>Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.</p><p><b>CONCLUSION</b>Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.</p>

Statins in adult patients with HIV Protocol for a systematic review and network meta-analysis

BACKGROUND: Patients with HIV have been found to suffer from lipid abnormalities, including elevated levels of total and LDL cholesterol as well as triglyceride levels. Abnormal lipid levels are associated with an increased risk of developing cardiovascular diseases, which are significant causes of mortality among the general population. Therefore, the objective of the current study is to conduct a systematic review with network meta-analysis to compare the effects of statins classes on HIV patients. METHODS: Randomized clinical trials (RCTs) and observational studies published in English up to 31 December 2017, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching four electronic databases and cross referencing. Dual selection and abstraction of data will occur. The primary outcome will all-cause mortality, new event of acute myocardial infarction, stroke (hemorrhagic and ischemic), hospitalization for acute coronary syndrome and urgent revascularization procedures and cardiovascular mortality. Secondary outcomes will be assessment of the differences in change of total cholesterol (TC), low-density lipoprotein (LDL-C), apolipoprotein B (ApoB), high density lipoprotein (HDL-C). Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument for RCTs and the Strengthening the Reporting of Observational Studies in Epidemiology instrument for observational studies. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of statins that reduce cardiovascular mortality in HIV patients. A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used to assess the risk of bias in eligible RCTs. Results will be synthesized and analyzed using network meta-analysis (NMA). Overall strength of the evidence and publication bias will be evaluated. Subgroup and sensitivity analysis will also be performed. RESULTS AND CONCLUSION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The evidence will determine which combination of interventions are most promising for current practice and further investigation.

Metabolic syndrome and risk of stroke Protocol for an update systematic review and meta-analysis

INTRODUCTION: The metabolic syndrome is composed of several cardiovascular risk factors and has a high prevalence throughout the world. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between metabolic syndrome and stroke. The aim of this study is to examine this association of metabolic syndrome with stroke in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar. Studies that examined the association between metabolic syndrome and stroke, had a longitudinal or prospective cohort design, were conducted among in adults aged 40 to 70 years, provided sufficient data for calculating ORs or relative risk with a 95% CI, were published as original articles written in English or other languages, and have been published until December 2017 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators.

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators.