Wood's light as a noval diagnostic tool in aquagenic keratoderma.

Aquagenic keratoderma, also known as aquagenic wrinkling of the palms, transient reactive papulotranslucent acrokeratoderma, or transient aquagenic hyper-wrinkling, is an uncommon disorder that affects the palms and occasionally the soles. It presents with translucent whitish to yellowish papules and increased wrinkling upon water exposure. The frequency of this condition is yet to be determined among the general population. However, it is frequently observed in patients among patients with cystic fibrosis or carriers of the cystic fibrosis gene, with frequency estimated to be up to 41%. In this paper, we report the utility and novelty of Wood's light as a bedside adjunct tool to aid in diagnosing aquagenic keratoderma. To our knowledge, this is the first case reporting the use of Wood's light in diagnosing aquagenic keratoderma.

Secondary syphilis presenting with non-arteritic anterior ischemic optic neuropathy (NAION).

Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Syphilis is a significant public health issue, notably in (HIV) positive patients. Due to the absence of pathognomonic signs in secondary syphilis and its ability to present and mimic a wide variety of clinical findings, it gained the name "the Great imitator '(mimicker).' Herein, we describe a case of a 51-year-old man who presented with acute painless loss of vision of the right eye preceded by a few erythematous plaques with thick scales over bilateral legs and multiple discrete and confluent scaly papules over the palms and soles. During the hospital stay, a diagnosis of non-arteritic anterior ischemic optic neuropathy (NAION) as a manifestation of neurosyphilis is made. To the best of our knowledge, this is the first reported case of NAION as the presenting symptom of neurosyphilis in secondary syphilis in an immunocompetent patient.

Acceptance, Awareness, Attitude, and Practices Toward Heart Transplantation: A Saudi Based Survey.

Introductions: The awareness of brain death and heart donation (HD) among the Saudi population remains limited, coupled with negative attitudes toward heart donation, resulting in a significant gap between the demand for donor hearts and the available supply. This study aimed to comprehensively understand the current perceptions, attitudes, and practices of the Saudi population regarding HD, as well as identify the obstacles. The ultimate goal was to strengthen the local donor pool. Methods: A cross-sectional study was conducted from March to May 2023, employing a self-administered internet survey. The survey collected demographic information, assessed awareness, attitudes, and practices related to HD, and was completed by 1820 participants from various regions in Saudi Arabia. Data was analyzed using SPSS version 25 (SPSS Inc., Chicago, Illinois, USA). Chi-square test, Independent-samples t-test, one way analysis of variance test (ANOVA) and Spearman correlation coefficient was performed with the significance level set at p < 0.05. Results: A significant portion of the population (out of 1820 participants) lacked organ donation cards and were uncertain about the registration process. Participants displayed a moderate level of knowledge about HD, with roughly half holding unfavorable attitudes toward HD. A considerable percentage of participants 62.0% were unwilling to register as heart donors, but a majority (79.9%) were willing to contribute by disseminating information about HD. The study identified significant associations between knowledge scores and several factors, including age (p = 0.002), career (p = 0.000), possession of an organ donation card (p = 0.000), and a history of transplantation or organ donation among relatives (p = 0.000). A significant relationship was observed between attitude scores and several factors, including career (p = 0.001), Saudi region (p = 0.025), possession of an organ donation card (p = 0.000), and a history of transplantation or organ donation among relatives (p = 0.000). Conclusion: The study highlights the urgent need for increased awareness to bolster the number of local heart donors. The involvement of healthcare professionals and social campaigns is essential to enhance public knowledge and potentially boost the willingness of individuals to become donors.

How Does an Eating Disorder Affect Your Physical and Mental Health and How It Is Related to Sleeve Gastrectomy?

Background Obesity is the pandemic of this era. At the same time, the commercialisation of thinness has also increased its adversity. Dissatisfaction with body shape is leading to many eating disorders. These disorders further cause several health problems. It has been found that individuals with eating disorders experience insomnia, depression, and anxiety. It also affects the endocrine system and digestive systems of the body. The surgical approach provides a more efficient treatment of obesity with sustainable results. Sleeve gastrectomy is the most popular surgical treatment. Sleeve gastrectomy is one of the prominent bariatric surgeries. Patients going through sleeve gastrectomy not only lose weight but also improve their mental health. Objective This study assesses the relationship between obesity, eating disorders, and physical health. It also focuses on the prevalence of sleeve gastrectomy procedures in such individuals and their outcomes. Methods This study used a cross-sectional design and a convenient sampling technique. The obese individuals who had eating disorders residing in Medina Al-Munawara and Riyadh city were taken as the samples. Online questionnaires were shared with participants to collect their perspectives on their weight, eating disorders, and their impact on physical health. The study collected both retrospective and present data. Results A total sample of 335 participants was taken, of which 181 (54%) were females and 154 (46%) were males, with a mean BMI of 28.85±2.57. The fear of weight gain was found among 265 (79%) of participants, 151 (45%) were feeling guilt while eating, 275 (82%) were weighing themselves daily, 325 (97%) were unable to stop eating even when complete, and 117 (35%) were unable to control themselves when they have food. As per the methods of avoiding weight gain, 166 (49.6%) were skipping a meal, 157 (47%) were following a diet, 17 (5%) were inducing vomiting, and 16 (4.8%) reused laxatives and diuretics. A total of 158 (47.2%) were involved in sports, but it was reduced to 61 (18.25%) upon sickness. Only 24 (7%) participants had undergone sleeve gastrostomy, and 181 (54%) believed that their cravings had increased, 238 (71%) complained of dizziness, and 151 (45%) believed that fast food caused gut unrest. Conclusion Obese individuals who are going through eating disorders are psychologically and physically compromised. They consider skipping meals to be the most efficient means of weight loss, and only a small percentage prefer to go for sleeve gastrectomy.

Retention hyperkeratosis over surgical scar: case report and review of literature.

Background: Retention hyperkeratosis (RHK) is benign and commonly seen skin condition in dermatology clinics. Hyperkeratosis refers to the increased thickness of the outermost layer of skin stratum corneum. RHK occurs when there is abnormality of routine desquamation that can be associated with poor hygiene. There are various types of hyperkeratosis, and could be divided according to their etiology. Although RHK is commonly recognized by dermatologists it is rarely reported. To the best of our knowledge, this is the first reported case of RHK over surgical scar. Case Description: A 63-year-old male presented to our dermatology clinic with severe RHK over a midline sternotomy scar post-coronary artery bypass grafting (post-CABG) in which he developed over the past 8 years. Our patient's history was significant in avoiding touching the surgical area as he feared disturbing the healing process of his surgical wound We discussed in details as further examination and investigations took a place on clinic-base during his management. Conclusions: Since RHK is associated with poor hygiene as we have seen in our patient's case, it could be prevented by providing the patient instructions regarding his wound care and general hygiene postoperatively and management of hyperkeratosis differs depending on type, severity, and chronicity. Our case represents a rare extreme manifestation related to the fear of our patient cleaning surgical wounds.

Assessment of Knowledge and Attitudes Toward Palliative Care and End-of-Life Decision-Making in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Palliative care in Saudi Arabia has witnessed significant recent progress through the establishment of the Saudi Society for Palliative Care and the National Palliative Care Program. The objective of this study was to assess knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces among individuals residing in these regions. METHODS: Utilizing a cross-sectional survey-based research design, we assessed knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces. Participants were recruited through purposive sampling via social media. Data collection included demographic information, palliative care knowledge, attitudes toward palliative care, and cultural influences on end-of-life decisions. RESULTS: A total of 710 participants completed the survey, resulting in a response rate of 85%, with a balanced gender distribution, predominantly aged 25-54. Over half were healthcare providers, many possessing more than 15 years of healthcare experience. A substantial proportion had received formal palliative care training and had personal involvement in end-of-life decisions. While most participants demonstrated a good understanding of palliative care, knowledge gaps, especially regarding its timing, persisted. Generally, participants felt at ease discussing end-of-life care and believed in palliative care's effectiveness. Cultural influences on end-of-life decisions were perceived both positively and negatively, with some facing cultural challenges in palliative care. CONCLUSIONS: This study underscores a promising understanding of palliative care in Saudi Arabia alongside persistent misconceptions. It highlights the necessity for targeted education to rectify misperceptions, particularly concerning the initiation timing of palliative care. Cultural factors strongly impact end-of-life decisions, emphasizing the need for culturally sensitive healthcare discussions and provider training.

Factors Associated With Malnutrition in Hospitalized Cancer Patients in a National Oncology Center in Conflict-Affected Settings in Sana'a, Yemen: An Institution-Based Cross-Sectional Study.

Background Cancer can significantly impact the nutritional status of patients, which can worsen related complications and reduce the effectiveness of treatment. Malnutrition is a common complication among cancer patients, especially among older adults. This study aims to determine the prevalence of malnutrition among hospitalized cancer patients and identify factors associated with malnutrition. Methodology and methods The cross-sectional descriptive study was performed on 296 cancer patients admitted to the National Oncology Referral Center in Sana'a, Yemen, between February 1 and March 31, 2022. Malnutrition was diagnosed through clinical assessment and screening tools such as screening tools, body mass index (BMI), weight loss percentage, and mid-upper arm circumference (MUAC). Descriptive statistics, chi-square, and multivariable logistic regression analysis were used to assess factors associated with malnutrition. Results Of the 296 patients included in the analysis, most were female 225 (76.0%), and the mean age was 45.8 years. The prevalence of undernutrition, as determined by the BMI score, was 48 (16.2%). The prevalence of malnutrition was higher in females 37 (16.4%) compared to males 11(15.5%). The data indicated that 49% of hospitalized patients had experienced weight loss of 5% or more. Multivariable logistic regression analysis showed that single (AOR=12.93, 95% CI: 1.17-142.77) or widowed (AOR=11.51, 95% CI: 1.05-126.03) marital status, weight loss (AOR=7.56, 95% CI: 3.00-18.69), stomach cancer (AOR=6.77, 95% CI: 1.66-27.70), and breast cancer (AOR=2.60, 95% CI: 1.12-6.03) were associated with an increased risk of malnutrition. Conclusions  The study highlights the importance of evaluating and addressing the nutritional status of cancer patients, especially at the beginning and during treatment, to improve their clinical outcomes. Prospective studies are recommended to further investigate this issue.

Obesity Concerns and the Future of a Nation's Health: A Cross-Sectional Study of Physical Activity and Related Awareness of Doctors-in-The-Making, Staff, and Faculty in a Saudi Arabian Medical College.

Background: Saudi Arabian population has amongst the highest prevalence of obesity globally. Apart from nutritional measures, physical activity is considered a major modifiable risk factor for the prevention of obesity and its consequences. An insight into the physical activity and awareness parameters of healthcare professionals and those in the making can provide an insight into how prepared we are to deal with the epidemic of non-communicable diseases. The aim of this study is to find out about the degree of physical activity undertaken by the medical students, faculty and staff at the College of Medicine, King Khalid University, as well as their awareness regarding physical activity guidelines. Methods: This study surveyed 300 adult participants - medical students, faculty and staff - in the College of Medicine, King Khalid University. An international validated questionnaire was used to assess the physical activity profile of participants as well as BMI parameters. Moreover, awareness and knowledge of the recommended physical activity guidelines for adults were also assessed. Results: The study participants comprised around 83% students, 9% faculty members, and 7% staff members. Around 55% of the participants were male, while the rest were female. More than 65% of participants across all categories reported low levels of physical activity, with only about 4.5% of participants across various age groups reporting high levels of physical activity. There was no significant difference by gender across the group (P value = 0.227). Only 17% of the study participants were knowledgeable of the recommended physical activity guidelines for adults. Conclusion: We found a low level of physical activity as well as inadequate awareness about the physical activity guidelines amongst our study participants. This study reiterates the urgent need for well-researched and well-funded health promoting interventions to promote physical activity, especially in the context of health professions' education.

A comprehensive study of medically serious suicide attempts in France: incidence and associated factors.

AIMS: People who make medically serious suicide attempts (MSSAs) share a number of features with those who die by suicide, and are at a high risk of suicide themselves. Studies to date have mostly focused on clinical samples of MSSAs. An epidemiological examination at a national level can help to identify risk profiles and pathways of care in this population. METHODS: We explored the French nationwide hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI) to identify any MSSA taking place between 2012 and 2019. Relevant demographic and medical information was collected about the first MSSA of each attempter. Data from 2010 and 2011 were used to verify the absence of prior attempts. RESULTS: First occurrences of MSSAs amounted to 81 959 cases over 8 years, with a mean age of 45.8 years, and 53.6% women. Incidence was higher in women (18.1 v. 17.3 per 1 00 000). The most common suicide method was deliberate self-poisoning (64.9% of cases). In comparison, violent methods associated higher mortality and comorbidity and were more frequent in men. The most common mental disorders were mood disorders (55.6%) and substance use disorders (46.2%). A minority of MSSA survivors were hospitalised in psychiatry (32.5%), mostly women. CONCLUSIONS: MSSAs are frequent and easy to identify. There is a need to reinforce the continuity of psychiatric care for this population given the high risk of subsequent suicide, and the low rates of psychiatric hospitalisation after an MSSA even if violent methods are used. Specific care targeting this population could reduce treatment gaps.

Acrodermatitis dysmetabolica secondary to isoleucine deficiency in infant with maple syrup urine disease.

Acrodermatitis dysmetabolica (AD) describes eruptions characterized by the clinical triad of acral dermatitis, diarrhea, and alopecia. AD can be caused by various metabolic disorders, one of which is maple syrup urine disease (MSUD). We present a 2- month-old boy diagnosed with MSUD by the age of 5 days and treated with branched-chain amino acid (BCAA) restricted diet, BCAAs formula, and thiamine supplementation. He was referred to dermatology with a 3-week history of diarrhea, progressive acrodermatitis enteropathica like cutaneous eruption and hair loss over the scalp treated with topical mometasone ointment, isoleucine supplementation and leucine restriction. Complete resolution of skin eruption was achieved by 4 weeks, which correlates with normalization of BCAA levels based on close monitoring of biochemical lab values and growth. This case emphasizes the dangers of limiting BCAA intake when treating MSUD, as well as the importance of close monitoring during the amino acid depleting period of growth.

Improving the leak detection efficiency in water distribution networks using noise loggers.

Leak detection techniques are effective ways of controlling water leakage in real water distribution networks (WDNs). Nevertheless, developing detection techniques for real WDNs has received little attention compared to the detection models developed based on laboratory simulated leaks. On the other hand, ambient noises and irregular water usage are difficult to simulate in a laboratory environment so detection models based on the laboratory simulated leaks are usually of low efficiency in practical applications. To achieve a better understanding of the detection models of real WDNs, machine learning (ML)-based leak detection models were developed in this work. This study employs wireless sensors to record acoustic signals emitted by real WDNs for the development of the leak detection models. The acquired acoustic signals are de-noised using the discrete wavelet transform. Thereafter, seventeen features are extracted from both the raw and de-noised signals using the principle of linear prediction, and the features are subsequently used for the development of the ML-based leak detection models. A thorough comparison is made for the performances of the detection models in terms of metal and non-metal WDNs, different features, and different ML algorithms, namely decision tree (DT), support vector machine (SVM), artificial neural network (ANN), and k-nearest neighbor (K-NN). Generally, the performance of the ML-based detection models developed by using the features extracted from de-noised signals has a better classification accuracy as compared to the performance of the models developed based on the features extracted from raw signals. For the de-noised signals, the accuracy, precision, and recall for the models developed based on the DT, SVM, and ANN algorithms are 100% for metal and non-metal WDNs.

Graham-Little Piccardi Lassueur syndrome and review of the literature.

Graham-Little Piccardi Lassueur Syndrome (GLPLS) is a rare variant of lichen planopilaris (LPP) which characterized by triad of fibrosing alopecia of the scalp, non-fibrosing alopecia of the axilla and groin, and a follicular spinous papule over the body. LPP is a rare follicular subtype of lichen planus which causes scarring alopecia of scalp, and there are three clinical subtypes of LPP including classic lichen planopilaris, frontal fibrosing alopecia, and GLPLS. Herein, we describe an adult dark-skinned Saudi male with GLPLS who has numerous body follicular papules, complete loss of axillary hair, and partial loss of groin hair in addition to patchy fibrosing alopecia of the scalp. To the best of our knowledge, this is the first reported case of GLPLS in Saudi Arabia.

Attitudes Towards Introduction of Multiple Modalities of Simulation in Objective Structured Clinical Examination (OSCE) of Emergency Medicine (EM) Final Board Examination: A Cross-Sectional Study.

PURPOSE: Objective Structured Clinical Examination (OSCE) is the current modality of choice for evaluating practical skills for graduating emergency medicine residents of final Saudi board examination. This study aims to evaluate the attitudes of both residents and faculty towards the idea of utilizing multiple modalities of simulation in a high-stakes emergency medicine (EM) examination. The goal is to propose a method to improve the process of this examination. PARTICIPANTS AND METHODS: The data were obtained using a cross-sectional survey questionnaire that was distributed to 141 participants, including both EM residents and instructors in the Saudi Board of Emergency Medicine. An online survey tool was used. The data were collected and subsequently analyzed to gauge the general and specific attitudes of both residents and instructors. RESULTS: Of the 141 participants, 136 provided complete responses; almost half were residents from all years, and the other half were primarily instructors (registrars, senior registrars, or consultants). Most of the participants from both groups (70% of the residents and 86% of the instructors) would like to see simulation incorporated into the final EM board OSCEs. Most of the participants (78%), however, had no experience with using multiple modalities of simulation in OSCEs. Overall, the majority (74.82%) expressed the belief that simulation-based OSCEs would improve the assessment of EM residents' competencies. The modalities that received the most support were part-task trainers and hybrid simulation (70.71% and 70%, respectively). CONCLUSION: From this study, we can conclude that both parties (residents and instructors) are largely willing to see multimodality simulation being incorporated into the final board examinations. Stakeholders should interpret this consensus as an impetus to proceed with such an implementation of multimodality simulation. Input from both groups should be considered when planning for such a change in this high-stakes exam.

Splenoptosis in young female, case report.

BACKGROUND: Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the intraabdominal cavity. This migration is the result of laxity or absence of the ligaments that fix the spleen to surrounding structures. Splenoptosis is either diagnosed after it causes symptoms, or incidentally using different imaging modalities. Surgery is the definite treatment either by splenopexy or splenectomy. CASE PRESENTATION: In the case presented here, we discuss a 17 years old female patient who presented to our institution for acute onset of abdominal pain, mainly suprapubic, occurring for 4 days. Ultrasound showed a suspicious right pelvic mass, which was found to be a wandering spleen with pedicle torsion. The patient was treated surgically by splenectomy. CONCLUSION: We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal pain.

Aortic pulse wave velocity in individuals of Asian and African ancestry: the HELISUR study.

Aortic pulse wave velocity has emerged as an important predictor of cardiovascular events, but data on ethnic differences in pulse wave velocity remain scarce. We explored differences in pulse wave velocity between people of Asian and African ancestry. Data were used from the cross-sectional Healthy Life in Suriname (HELISUR) study. Pulse wave velocity was estimated oscillometrically with the Arteriograph. We included 353 Asians and 364 Africans, aged respectively 44.9 (SD 13.5) and 42.8 (SD 14.1) years (p = 0.05). Crude median PWV was higher in Asians than in Africans (8.1 [IQR 6.9-10.1] m/s vs. 7.7 [IQR 6.5-9.3] m/s, p = 0.03), which was mainly attributable to an increased PWV in Asians ≥ 50 years (10.1 [IQR 8.7-11.8] m/s vs. 9.1 [IQR 7.9-11.3] m/s in Africans ≥50 years, p < 0.01). After adjustment for age and MAP in multivariable linear regression, Asians had a 1.044 [95% CI 1.019-1.072] m/s higher PWV compared to Africans. Additional adjustment for sex, glucose, total cholesterol, HDL cholesterol, triglycerides, BMI, and waist circumference did not substantially change the difference in pulse wave velocity between Asians and Africans (+1.044 [95% CI 1.016-1.074] m/s for Asians vs. Africans). In conclusion, persons of Asian ancestry have a higher pulse wave velocity than those of African ancestry. This persisted after adjustment for important cardiovascular risk parameters, including age and blood pressure. The higher PWV found in Asians could be consistent with their increased coronary heart disease risk.

Assessment and modeling of microalgae growth considering the effects OF CO2, nutrients, dissolved organic carbon and solar irradiation.

The present study assesses and models the growth of microalgae during the combined processes of concurrent eliminations of CO2 from off-gas and nutrients from wastewater. The growth of single (Spirulina platensis, SP.PL) and mixed (mixed indigenous microalgae, MIMA) algae strains was tested in a pilot plant under natural conditions. The specific growth rate (µ), biomass production (Pbio), CO2 biofixation rate (RCO2), and contaminate (organic matter and nutrient) reductions were investigated in response to the changes in concentration of CO2, nutrient and organic matters as well as solar irradiation. A mathematical model that incorporates the effect of growth variables: organic matter (COD), total inorganic nitrogen (TIN), total phosphate (TP), solar irradiation and dissolved CO2 was developed to predict the strains growth rate. The maximum value of µ for single strain was determined to occur at 40 mg COD/L, 20 mg-N/L, 8.9 mg-P/L, 12% CO2 (v/v) and 7.45 µE/m2.s. MIMA showed a maximum value of µ at 55 mg COD/L, 17 mg-N/L, 10 mg-P/L, 17% CO2 and 8.45 µE/m2.s. The predicted growth rates confirmed the ability of the model to match experimental data. Microalgae can be successfully used in sustainable CO2 capturing and wastewater treatment technology.

Monitoring and measurement of microalgae using the first derivative of absorbance and comparison with chlorophyll extraction method.

Monitoring of microalgae in water supplies and industrial applications are becoming increasingly important, yet there are few options available that are simple and accurate, and can provide real-time information. The present work illustrates a new method to determine the concentration of microalgae in water and wastewater using spectrophotometry and the first derivative of absorbance. Chlorella vulgaris was used as an indicator microalga, spiked in water samples representing a range of water qualities (distilled water, surface water, and wastewater), and correlations among C. vulgaris concentrations, absorbance, and the first derivative of absorbance measurements were investigated. In addition, detection limits were established and sensitivity analyses were carried out to determine the lowest C. vulgaris concentrations that can be confidently measured in different water matrices. Finally, the study compared the performance and detection limits of the spectrophotometry-based methods with the well-accepted chlorophyll extraction method. A strong linear relationship (R2 > 0.97) was found between C. vulgaris concentration and absorbance at 695 nm. Using the first derivative of absorbance improved C. vulgaris detection limits by reducing the effects of the background noise and interferences from other substances. The detection limits established using the first derivative method were 0.47, 0.56, and 1.96 mg TVS/L in distilled water, surface water, and wastewater, respectively. In comparison, the detection limits of the chlorophyll extraction method were found to be 19.6, 38.6, and 48.3 mg TVS/L in the same water matrices. These results indicate that first derivative of absorbance can be successfully used for monitoring of microalgae in surface waters and environmental samples as well as in bioreactors used for microalgae cultivation in industrial applications.

Creatine kinase and renal sodium excretion in African and European men on a high sodium diet.

Creatine kinase (CK) rapidly regenerates ATP for Na+ /K+ -ATPase driven sodium retention throughout the kidney. Therefore, we assessed whether resting plasma CK is associated with sodium retention after a high sodium diet. Sixty healthy men (29 European and 31 African ancestry) with a mean age of 37.2 years (SE 1.2) were assigned to low sodium intake (< 50 mmol/d) during 7 days, followed by 3 days of high sodium intake (> 200 mmol/d). Sodium excretion (mmol/24-h) after high sodium was 260.4 (28.3) in the high CK tertile versus 415.2 (26.3) mmol/24-h in the low CK tertile (P < .001), with a decrease in urinary sodium excretion of 98.4 mmol/24-h for each increase in log CK, adjusted for age and African ancestry. These preliminary results are in line with the energy buffering function of the CK system, but more direct assessments of kidney CK will be needed to further establish whether this enzyme enhances sodium sensitivity.

Hypertension and Cardiovascular Risk Profile in a Middle-Income Setting: The HELISUR Study.

BACKGROUND: Hypertension is the leading risk factor responsible for premature death worldwide, but its burden has shifted to low- and middle-income countries. Therefore, we studied hypertension and cardiovascular risk in the population of Suriname, a middle-income country with a predominantly urban population of African and Asian ancestry. METHODS: A random sample of 1,800 noninstitutionalized men and women aged 18-70 years was selected to be interviewed at home and examined at the local hospital for cardiovascular risk factors, asymptomatic organ damage, and cardiovascular disease. RESULTS: The 1,157 participants examined (37% men) were mainly of self-defined Asian (43%) or African (39%) ancestry, mean age 43 years (SD 14). The majority of the population (71%) had hypertension or prehypertension, respectively, 40% and 31%. Furthermore, 72% was obese or overweight, while 63% had diabetes or prediabetes. Only 1% of the adult population had an optimal cardiovascular risk profile. Hypertension awareness, treatment, and control were respectively 68%, 56%, and 20%. In line with this, 22% of the adult population had asymptomatic organ damage, including increased arterial stiffness, left ventricular hypertrophy, microalbuminuria, or asymptomatic chronic kidney disease. CONCLUSIONS: In this first extensive cardiovascular assessment in the general population of this middle-income Caribbean country, high prevalence of hypertension with inadequate levels of treatment and control was predominant. The findings emphasize the need for collaborative effort from national and international bodies to prioritize the implementation of affordable and sustainable public health programs that combat the escalating hypertension and cardiovascular risk factor burden.

The acute effect of beta-guanidinopropionic acid versus creatine or placebo in healthy men (ABC-Trial): A randomized controlled first-in-human trial.

AIMS: Increasing evidence indicates that the ATP-generating enzyme creatine kinase (CK) is involved in hypertension. CK rapidly regenerates ATP from creatine phosphate and ADP. Recently, it has been shown that beta-guanidinopropionic acid (GPA), a kidney-synthesized creatine analogue and competitive CK inhibitor, reduced blood pressure in spontaneously hypertensive rats. To further develop the substance as a potential blood pressure-lowering agent, we assessed the tolerability of a sub-therapeutic GPA dose in healthy men. METHODS: In this active and placebo-controlled, triple-blind, single-centre trial, we recruited 24 healthy men (18-50 years old, BMI 18.5-29.9 kg m-2 ) in the Netherlands. Participants were randomized (1:1:1) to one week daily oral administration of GPA 100 mg, creatine 5 g, or matching placebo. The primary outcome was the tolerability of GPA, in an intent-to-treat analysis. RESULTS: Twenty-four randomized participants received the allocated intervention and 23 completed the study. One participant in the placebo arm dropped out for personal reasons. GPA was well tolerated, without serious or severe adverse events. No abnormalities were reported with GPA use in clinical safety parameters, including physical examination, laboratory studies, or 12-Lead ECG. At day 8, mean plasma GPA was 213.88 (SE 0.07) in the GPA arm vs. 32.75 (0.00) nmol l-1 in the placebo arm, a mean difference of 181.13 (95% CI 26.53-335.72). CONCLUSION: In this first-in-human trial, low-dose GPA was safe and well-tolerated when used during 1 week in healthy men. Subsequent studies should focus on human pharmacokinetic and pharmacodynamic assessments with different doses.