Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Proposing a reporting method for neurosonological assessments in case of carotid stenosis to try to clear the clutter. This is how we do...what about you?

Objective: Sharing research on establishing a standardized language for ultrasound (US) evaluation of carotid stenosis, based on examination reports, addressing the current heterogeneity in terminology and measurements. Materials: Carotid US reports often mention stenosis percentages and severity adjectives. However, the variability in calculating steno- sis range and lack of reproducibility with digital angiography pose challenges, resulting in ambiguous conclusions and interpretation-dependent outcomes. Methods: We retrospectively collected carotid stenosis Doppler US reports from patients admitted to our Neurology department between January and December 2022. Definitions of stenosis degree, method used (NASCET or ECST), severity adjectives, and terms related to hemodynamic significance, near occlusion and collateral circulation were examined. Results: A total of 104 carotid US reports were collected, with 54 also including transcranial color Doppler US for cerebral circulation evaluation. Neurologists conducted 48 examinations, while other specialists performed the rest. Precise percentage diagnoses were reported in 43 exams, while stenosis range was mentioned in 26 exams. NAS- CET and ECST methods were used in 41 and 23 exams, respectively. Severity adjectives like "moderate" and "critical" were present in 22 and 13 exams respectively. "Collateral circulation" and "near occlu- sion" were noted in 42 and 9 exams respectively. Discussion: US has been used for detecting carotid plaques for decades, but discrepancies exist in how carotid stenosis is assessed and defined, not only because of the differences between angiography and US metrics but also because of the high heterogeneity of findings descriptions in the reports. In our opinion, in advanced settings with adequate expertise, it may be feasible to abandon the dichotomous description extracranial/intracranial findings and adopt a new definition: neurosonological study of carotid and vertebro-basilar circulation. Usage of NASCET stenosis range based on velocity criteria and consideration of "unstable plaque" characteristics would be beneficial. Also, different velocity cut-off in symptomatics and asymptomatics for < and > 50%, < and > 70% carotid stenosis should probably be considered. Conclusions: Accurate carotid stenosis diagnosis with US requires integrating pathophysiological knowledge, clinical evaluation and multiparametric US measurements. Reports should not be limited to measurements but should represent a synthesis of information. In the case of stenosis, the report should encompass local findings as well as those from upstream and downstream circulation, following the pathophysiology of cerebral circulation rather than relying solely on topographical anatomy. Categorizing stenosis within a range helps estab- lish treatment boundaries, although overall clinical and instrumental assessments remain crucial for decision-making both in symptomatics and asymptomatics

Ictal Fear or Panic Attack, This Is the Question—A Video–EEG Study

Panic disorder (PD) and focal epilepsy, in particular, temporal lobe epilepsy, often present diagnostic challenges due to overlapping clinical manifestations. This article describes the case of a 25-year-old female, misdiagnosed with PD for 15 years, whose recurring episodes of sudden fear, palpitations, and nausea were later identified as manifestations of focal epilepsy. Initially unresponsive to conventional anti-anxiety medications, the patient’s correct diagnosis was only established through comprehensive electro-clinical, neuropsychological, and neuroimaging evaluations during her admission to our research hospital. Long-term video–EEG monitoring (LTVEM) played a pivotal role in identifying the epileptic nature of her episodes, which were characterized by paroxysmal activity in the right temporal and zygomatic regions, consistent with the location of a dysplastic lesion in the right amygdala, as revealed by high-resolution magnetic resonance imaging. These findings underline the importance of considering focal epilepsy in the differential diagnosis of PD, especially in cases refractory to standard psychiatric treatments. The misdiagnosis of epilepsy as PD can lead to significant delays in appropriate treatment, potentially exacerbating the patient’s condition and affecting their quality of life. This case emphasizes the necessity of a multidisciplinary approach and the utilization of advanced diagnostic tools like LTVEM in elucidating the underlying causes of paroxysmal psychiatric symptoms

Sodium-glucose cotransporter-2 inhibitors: A potential novel treatment for Lafora disease?

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