An echocardiographic-confirmed case of atrial myxoma causing cerebral embolic ischemic stroke: a case report

A myxoma is the most common primary tumor of the heart. It has been reported as the source of a cardiogenic embolism. Therefore, it is important for clinicians to detect the myxoma early via echocardiography to prevent complications, such as syncope, sudden death, and cerebral embolic ischemic stroke. This report presents the case of a 54-year-old female whose clinical manifestation of atrial myxoma was an ischemic stroke. Atrial myxoma was later confirmed as the cause of her symptoms via transesophageal echocardiography

Governance of private forests in Eastern and Central Europe: An analysis of forest harvesting and management rights

A property rights-based approach is proposed in the paper to underlinethe common characteristics of the forest property rights specificationin ten ECE countries, the specific patterns governing the harvesting of timber in private forestry and the role of the forest management planning in determining the content of the property rights. The analysis deals with the private forests of the individuals (non industrial ownership) from ten countries, covering 7.3 million ha and producing yearly some 25 million timber. The study shows that the forest management rights in private forests belong to the State and that the withdrawal rights on timber, yet recognized in the forest management plans, are in reality strongly restricted from aneconomic viewpoint. The forest management planning is the key instrument of the current forest governance system, based on top-down, hierarchically imposed and enforced set of compulsory rules on timber harvesting. With few exceptions, the forest owners’ have little influence in the forest planning and harvesting. The rational and State-lead approach of the private forest management has serious implications not only on the economic content of the property rights, but also on the learning and adaptive capacity of private forestry to cope with current challenges such the climate change, the increased industry needs for wood as raw material, or the marketingof innovative non wood forest products and services. The study highlights that understanding and comparing the regime of the forest ownership require a special analysis of the economic rights attached to each forest attribute; and that the evolution towards more participatory decision-making in the local forest governance can not be accurately assessed in ECE region without a proper understanding of the forest management planning process

Efficacy and safety of colchicine in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

Background: Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials (RCTs) have investigated the potential benefit of colchicine in reducing cardiovascular events (CE) in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD. Methods: We systematically searched selected electronic databases from inception until 10th December 2020. Primary clinical endpoints were: major adverse cardiac events (MACE), allcause mortality, cardio-vascular (CV) mortality, recurrent myocardial infarction (MI), stroke, hospitalization and adverse medication effects. Secondary endpoints were short-term effect of colchicine on inflammatory markers. Results: Twelve RCTs with a total of 13,073 patients with CAD (colchicine n=6351 and placebo n=6722) were included in the meta-analysis. At mean follow-up of 22.5 months, the colchicine group had lower risk of MACE (6.20% vs. 8.87%; p<0.001), recurrent MI (3.41% vs. 4.41%; p=0.005), stroke (0.40% vs. 0.90%; p=0.002) and hospitalization due to CE (0.90% vs. 2.87%; p=0.02) compared to the control group. The two patient groups had similar risk for all-cause mortality (2.08% vs. 1.88%; p=0.82) and CV mortality (0.71% vs. 1.01%; p=0.38). Colchicine significantly reduced hs-CRP (-4.25, p=0.001) compared to controls but did not significantly affect IL-β1 and IL-18 levels. Conclusions: Colchicine reduced cardiovascular events and inflammatory markers, hs-CRP and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation

Complicanze chirurgiche in pazienti sottoposti a decompressione orbitaria per oftalmopatia di Graves

L'obiettivo di questo studio è analizzare le complicanze della decompressione orbitaria in pazienti affetti da oftalmopatia Basedowiana. Abbiamo analizzato 946 pazienti sottoposti a decompressione orbitaria per orbitopatia di Graves e le complicanze intra- e post-operatorie con un follow-up minimo di 6 mesi. Abbiamo eseguito inoltre un'estesa revisione della letteratura per comparare i risultati. Nel nostro studio le più frequenti complicanze sono state: atrofia della regione temporale (100%) nei pazienti sottoposti a decompressione con approccio coronale; ipoestesia permanente di V2 (13%) e V1 (8%) in pazienti sottoposti a decompressione con approccio transpalpebrale superiore. Un solo paziente ha avuto una lesione totale monolaterale di V2. Le complicanze più gravi sono state la riduzione dell'acuità visiva, che si è verificata in 5 pazienti, e la perdita di liquido cerebrospinale con complicanze cerebrali, verificatesi in 2 pazienti, entrambi operati con approccio endonasale non endoscopico. 3 pazienti hanno avuto un'emorragia intraoperatoria mentre 3 pazienti un'emorragia postoperatoria che ha richiesto un secondo intervento chirurgico. L'incidenza delle sinusiti/mucoceli sintomatici è stata dello 0,75%. In conclusione abbiamo evidenziato come la decompressione orbitaria eseguita con tecnica endoscopica endonasale e con accessi transpalpebrali sia una procedura chirurgica con una bassa incidenza di complicanze. La conoscenza delle cause delle possibili complicanze nei differenti approcci chirurgici può sicuramente aiutare a ridurre la loro incidenza

Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP)

Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy

The Association Between Daily Step Count and All-Cause and Cardiovascular Mortality: A Meta-Analysis

Aims There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality.Methods and results We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81–0.91; P < 0.001], while a 500-step increment was associated with a 7% decrease in CV mortality (HR 0.93; 95% CI 0.91–0.95; P < 0.001). Compared with the reference quartile with median steps/day 3867 (2500–6675), the Quartile 1 (Q1, median steps: 5537), Quartile 2 (Q2, median steps 7370), and Quartile 3 (Q3, median steps 11 529) were associated with lower risk for all-cause mortality (48, 55, and 67%, respectively; P < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference [median steps 2337, interquartile range 1596–4000), higher quartiles of steps/day (Q1 = 3982, Q2 = 6661, and Q3 = 10 413) were linearly associated with a reduced risk of CV mortality (16, 49, and 77%; P < 0.05, for all). Using a restricted cubic splines model, we observed a nonlinear dose–response association between step count and all-cause and CV mortality (Pnonlineraly < 0.001, for both) with a progressively lower risk of mortality with an increased step count.Conclusion This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3867 steps/day for all-cause mortality and only 2337 steps for CV mortality

The Rise and Fall of Hypertension: Lessons Learned from Eastern Europe

Hypertension is a progressive cardiovascular syndrome that arises from many differing, but interrelated, etiologies. Hypertension is the most prevalent cardiovascular disorder, affecting 20% to 50% of the adult population in developed countries. Arterial hypertension is a major risk factor for cardiovascular diseases and death. Epidemiologic data have shown that control of hypertension is achieved in only a small percentage of hypertensive patients. Findings from the World Health Organization project Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) showed a remarkably high prevalence (about 65%) of hypertension in Eastern Europeans. There is virtually no difference however, between the success rate in controlling hypertension when comparing Eastern and Western European populations. Diagnosing hypertension depends on both population awareness of the dangers of hypertension and medical interventions aimed at the detecting elevated blood pressure, even in asymptomatic patients. Medical compliance with guidelines for the treatment of hypertension is variable throughout Eastern Europe. Prevalence of hypertension increases with age, and the management of hypertension in elderly is a significant problem. The treatment of hypertension demands a comprehensive approach to the patient with regard to cardiovascular risk and individualization of hypertensive therapy

Efficacy and safety of bempedoic acid for the treatment of hypercholesterolemia: A systematic review and meta-analysis

Background Bempedoic acid is a first-in-class lipid-lowering drug recommended by guidelines for the treatment of hypercholesterolemia. Our objective was to estimate its average effect on plasma lipids in humans and its safety profile. Methods and findings We carried out a systematic review and meta-analysis of phase II and III randomized controlled trials on bempedoic acid (PROSPERO: CRD42019129687). PubMed (Medline), Scopus, Google Scholar, and Web of Science databases were searched, with no language restriction, from inception to 5 August 2019. We included 10 RCTs (n = 3,788) comprising 26 arms (active arm [n = 2,460]; control arm [n = 1,328]). Effect sizes for changes in lipids and high-sensitivity C-reactive protein (hsCRP) serum concentration were expressed as mean differences (MDs) and 95% confidence intervals (CIs). For safety analyses, odds ratios (ORs) and 95% CIs were calculated using the Mantel–Haenszel method. Bempedoic acid significantly reduced total cholesterol (MD −14.94%; 95% CI −17.31%, −12.57%; p &lt; 0.001), non-high-density lipoprotein cholesterol (MD −18.17%; 95% CI −21.14%, −15.19%; p &lt; 0.001), low-density lipoprotein cholesterol (MD −22.94%; 95% CI −26.63%, −19.25%; p &lt; 0.001), low-density lipoprotein particle number (MD −20.67%; 95% CI −23.84%, −17.48%; p &lt; 0.001), apolipoprotein B (MD −15.18%; 95% CI −17.41%, −12.95%; p &lt; 0.001), high-density lipoprotein cholesterol (MD −5.83%; 95% CI −6.14%, −5.52%; p &lt; 0.001), high-density lipoprotein particle number (MD −3.21%; 95% CI −6.40%, −0.02%; p = 0.049), and hsCRP (MD −27.03%; 95% CI −31.42%, −22.64%; p &lt; 0.001). Bempedoic acid did not significantly modify triglyceride level (MD −1.51%; 95% CI −3.75%, 0.74%; p = 0.189), verylow-density lipoprotein particle number (MD 3.79%; 95% CI −9.81%, 17.39%; p = 0.585), and apolipoprotein A-1 (MD −1.83%; 95% CI −5.23%, 1.56%; p = 0.290). Treatment with bempedoic acid was positively associated with an increased risk of discontinuation of treatment (OR 1.37; 95% CI 1.06, 1.76; p = 0.015), elevated serum uric acid (OR 3.55; 95% CI 1.03, 12.27; p = 0.045), elevated liver enzymes (OR 4.28; 95% CI 1.34, 13.71; p = 0.014), and elevated creatine kinase (OR 3.79; 95% CI 1.06, 13.51; p = 0.04), though it was strongly associated with a decreased risk of new onset or worsening diabetes (OR 0.59; 95% CI 0.39, 0.90; p = 0.01). The main limitation of this meta-analysis is related to the relatively small number of individuals involved in the studies, which were often short or middle term in length. Conclusions Our results show that bempedoic acid has favorable effects on lipid profile and hsCRP levels and an acceptable safety profile. Further well-designed studies are needed to explore its longer-term safety