Serum 25-hydroxyvitamin D levels are associated with functional capacity but not with postural balance in osteoporotic postmenopausal women

OBJECTIVES: In post-menopausal women with osteoporosis, insufficient vitamin D levels decrease calcium fixation in the bones and calcium transport in the sarcoplasmic reticulum, which impairs muscle strength, possibly leading to detrimental consequences for the preservation of functional capacity and postural balance, fall prevention, and fracture risk. The aim of this study was to evaluate the association between vitamin D levels and knee muscle strength, postural balance and functional mobility among postmenopausal women with osteoporosis. METHODS: This cross-sectional study included 63 osteoporotic older women (aged 60.6±3.1 years). The subjects completed the Timed Up and Go Test to measure functional mobility, and postural balance was assessed on the AccuSway Plus portable force platform. Maximal strength was tested using an isokinetic dynamometer for knee flexion and extension. The subjects were assessed as a group and were divided into quartiles according to their vitamin D levels. Clinicaltrials.gov: NCT02771834. RESULTS: Vitamin D status was independently associated with the normalized peak torque of the knee extensors (β=0.59; p=0.04) and Timed Up and Go Test (β=-0.07;

Acute aerobic exercise reduces 24-h ambulatory blood pressure levels in long-term-treated hypertensive patients

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5±8.2 years; Body mass index: 27.8±4.7 kg/m²) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60% of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126±8.6 vs. 123.1±8.7 mmHg, p=0.004) and diastolic blood pressure (81.9±8 vs. 79.8±8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5±8.5 vs. 83.9±8.8 mmHg, p=0.04), and nighttime S (116.8±9.9 vs. 112.5±9.2 mmHg,

Distinct cortical and subcortical structural alterations mirroring daytime‐related seizure occurrence [Abstract]

Purpose: Investigating the daytime‐related patterns of sei-zure presentation might provide important insights into theinvolved epileptogenic networks. However, the alterationsof brain structural integrity linked to different profiles ofseizure occurrence are still not clear. In this study weaddressed the structural magnetic resonance imaging(MRI)‐derived features of the involved cortical and subcor-tical substrates. Method: In 13 patients (mean age ± standard deviation:28±9 years; 9 male) with nocturnal seizures (NS), 12patients (26±9; 3 male) with diurnal seizures (DS) and 10healthy controls (HC) (28±4; 6 male) 3D 3T MRI was per-formed. Cortical and subcortical volumes (hippocampus,amygdala, thalamus) were extracted with the FreeSurferprocessing stream and the between‐group differencesassessed with analysis of variance (ANOVA) and Bonfer-roni post hoc tests. There was no difference between thegroups regarding age (F2,32= 0.26, p = 0.77) and gender(χ†= 5.103, df = 2, p = 0.08). Results: NS group in contrast to DS group showed largervolumes of bilateral insula, superior temporal and orbito-frontal cortices (p = 0.05, corrected). In patients with NScortical volumes of left postcentral and right middle tempo-ral cortices were smaller in comparison to HC. Patientswith DS in comparison to HC displayed reduced corticalvolumes mainly in frontal, temporal and parietal lobes ofthe right hemisphere. Hippocampus analysis showed a sig-nificant group difference (F2,32= 3.643, p = 0.03) withpost hoc test indicating larger volumes in NS group(8208.6±1006.1) vs DS group (3859.1±508.1 mm‡,p = 0.02). For amygdala, ANOVA showed a similar signif-icant group difference (F2,32= 4.341, p = 0.02) with largervolumes in NS group (1797.3±323.2 mm‡) vs DS group(1500.5±246.2 mm‡, p = 0.03). There were no differencesin thalamic volumes between the studied groups. Conclusion: Despite epileptogenesis daytime‐related sei-zures have distinct structural correlates. These alterationscan assign protective or susceptibility properties linked tovigilance or sleep states that could be useful for therapeuticdecisions

CSF markers of blood-brain barrier integrity forecast disease progression in early MS [Abstract]

Background and aim: Cortical atrophy, reflecting neuronal loss, is highly associated with long-term disability in patients with multiple sclerosis (MS). In this longitudinal study we link cerebrospinal fluid (CSF) markers of blood-brain barrier (BBB) integrity to longitudinal cortical atrophy and clinical disability. Methods: 71 relapsing-remitting multiple sclerosis (RRMS) patients (31.2 ± 9.4 (mean ± SD), 25 males) were included in this longitudinal study. CSF and serum samples were obtained from each patient at the time of first clinical event. We analyzed CSF levels of albumin (AlbCSF), immunoglobulin A (IgACSF), IgG (IgGCSF) and IgM (IgMCSF). All patients underwent MR imaging twice with the same standardized protocol (follow-up after 12 ± 1 months) at 3T (Siemens Magnetom Trio). Longitudinal changes of cortical thickness (CT) were extracted using the FreeSurfer processing stream. The Expanded Disability Status Scale (EDSS) score at follow-up was used as a clinical outcome measure to quantify clinical disability. The rate of cortical atrophy was assessed in relation to CSF variables. Results: Baseline AlbCSF and IgACSF were highly associated with the rate of cortical atrophy over one year. Significant correlations were found in the precuneus (PrC), rostral middle frontal, precentral and inferior parietal gyri of both hemispheres. The regions with the highest atrophy rates were the right PrC (R = 0.604, p < 0.001) and left fusiform gyrus (R = 0.539, p < 0.001). IgACSF and IgMCSF (IgA: 1.67 ± 0.69 mg/l vs 2.03 ± 0.71 mg/l, IgM: 9.87 ± 2.38 mg/l vs 11.5 ± 2.03 mg/l; p = 0.04 and p = 0.003, respectively) significantly differed between patients with no disability (EDSS 0 - 1.5) and those with mild to moderate disability (EDSS 2 - 6) at the second time point. Conclusion: Our data show that widespread cortical atrophy is highly associated with increased baseline CSF Albumin and IgA mirroring a permeable BBB. Patients with this BBB pattern showed higher functional disability at follow-up. These parameters could be addressed to dichotomize patients at risk of rapid disease progression

COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock

Cosmin Iosif Trebuian,1,2 Daian Popa,3,4 Florina Buleu,5,6 Dumitru Sutoi,1,5 Carmen Gabriela Williams,3 Iulia Najette Crintea,1,3 Raul Daniel Chioibas,1 Aida Iancu,7 Livia Ciolac,8 Ovidiu Alexandru Mederle1,3 1Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania; 2Emergency County Hospital, Reșita, Romania; 3Emergency Clinical Municipal Hospital, Timisoara, Romania; 4“victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Emergency County Hospital “pius Brinzeu”, Timișoara, Romania; 6Department of Cardiology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 7Department of Radiology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 8Clinic of Obstetrics and Gynecology, ”pius Brinzeu” County Clinical Emergency Hospital, Timisoara, RomaniaCorrespondence: Florina Buleu, Email [email protected] and Objectives: Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients.Material and Methods: This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit.Results: Patients with a mean age of 73 (IQR 62– 82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53– 0.759) for leukocytes, 0.613 (95% CI: 0.509– 0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548– 0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS.Conclusion: Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.Keywords: pulmonary septic shock, severe ARDS, inflammatory biomarkers, COVID-19, outcome

Assessment of Left Ventricular Geometrical Patterns and Function among Hypertensive Patients at a Tertiary Hospital, Northern Tanzania.

With hypertension, the cardiovascular system changes to adapt to the varying neuro-humoral and hemodynamic changes and this may lead to the development of different left ventricular geometric patterns, each carrying a different risk profile for major adverse cardiovascular events. Using a consecutive sampling technique, a cross-sectional, prospective, hospital based study was done and two hundred and twenty seven (227) hypertensive patients were studied. The distribution of different abnormal LV geometrical patterns was 19.8%, 28.2%, 22% for concentric remodelling, concentric hypertrophy and eccentric hypertrophy respectively. With echocardiographic criteria, the proportion of patients with left ventricular hypertrophy (LVH) was higher when left ventricular mass (LVM) was indexed to height(2.7) than to body surface area (70.0% vs. 52.9%). Duration of hypertension markedly influenced the type of LV geometry with normal LV geometry predominating in early hypertension and abnormal geometrical patterns predominating in late hypertension. The left ventricular fractional shortening decreased with duration of hypertension and was common in patients with eccentric hypertrophy. Age of the patient, systolic blood pressure, duration of hypertension and body mass index were found to be independent predictors left ventricular hypertrophy. About 70% of hypertensive patients had abnormal geometry existing in different patterns. Eccentric hypertrophy had more of clinical and echocardiographic features suggestive of reduced left ventricular systolic function. Hypertensive patients should be recognized as a heterogeneous population and therefore stratifying them into their respective LV geometrical patterns is useful as way of assessing their risk profile as well as instituting appropriate management

Viability of high intensity interval training in persons with spinal cord injury-a perspective review

Spinal cord injury (SCI) leads to loss of sensory and motor function below the level of injury leading to paralysis and limitations to locomotion. Therefore, persons with SCI face various challenges in engaging in regular physical activity, which leads to a reduction in physical fitness, increases in body fat mass, and reduced physical and mental health status. Moderate intensity continuous training (MICT) is recommended to enhance physical fitness and overall health status in this population, but it is not always effective in promoting these benefits. High intensity interval training (HIIT) has been promoted as an alternative to MICT in individuals with SCI due to its documented efficacy in healthy able-bodied individuals as well as those with chronic disease. However, the body of knowledge concerning its application in this population is limited and mostly composed of studies with small and homogeneous samples. The aim of this review was to summarize the existing literature regarding the efficacy of HIIT on changes in health- and fitness-related outcomes in this population, denote potential adverse responses to HIIT, describe how participants perceive this modality of exercise training, and identify the overall feasibility of interval training in persons with SCI.</p