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1.
Cureus ; 16(4): e58673, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38774170

ABSTRACT

Abdominal aortic aneurysms (AAAs) pose significant challenges in clinical management, particularly in female patients, whose unique anatomical and physiological characteristics influence rupture risk. While aortic diameter (AD) has traditionally been the primary metric for predicting rupture, its limitations, especially in women, have spurred exploration into alternative measures such as the aortic size index (ASI). This review examines the anatomy and physiology of AAAs in women, gender-specific challenges in diagnosis and management, and the comparative effectiveness of ASI versus AD in predicting rupture risk. ASI, calculated as AD divided by body surface area (BSA), offers a more nuanced assessment by adjusting for individual body size differences, potentially mitigating gender disparities in rupture rates. Comparative analyses indicate ASI's superiority in predicting adverse aortic events, particularly in women, thereby advocating for its integration into clinical practice to improve patient outcomes. Additionally, emerging techniques such as 3D volumetric measurements and biomechanical assessments show promise in enhancing rupture risk prediction, heralding a shift toward more personalized and effective management strategies for AAA patients.

2.
Article in English | MEDLINE | ID: mdl-38616461

ABSTRACT

BACKGROUND/OBJECTIVES: Recent trends indicate a rise in the incidence of critical limb ischemia (CLI) among younger adults. This study examines trends in CLI hospitalization and outcomes among young adults with peripheral arterial disease (PAD) in the United States. METHODS: Adult hospitalizations (18-40 years) for PAD/CLI were analyzed from the 2016-2020 nationwide inpatient sample database using ICD-10 codes. Rates were reported per 1000 PAD or 100,000 cardiovascular disease admissions. Outcomes included trends in mortality, major amputations, revascularization, length of hospital stay (LOS), and hospital costs (THC). We used the Jonckheere-Terpstra tests for trend analysis and adjusted costs to the 2020 dollar using the consumer price index. RESULTS: Approximately 63,045 PAD and 20,455 CLI admissions were analyzed. The mean age of the CLI cohort was 32.7 ± 3 years. The majority (12,907; 63.1 %) were female and white (11,843; 57.9 %). Annual CLI rates showed an uptrend with 3265 hospitalizations (227 per 1000 PAD hospitalizations, 22.7 %) in 2016 to 4474 (252 per 1000 PAD hospitalizations, 25.2 %) in 2020 (Ptrend<0.001), along with an increase in PAD admissions from 14,405 (188 per 100,000, 0.19 %) in 2016 to 17,745 (232 per 100,000, 0.23 %%) in 2020 (Ptrend<0.0001). Annual in-hospital mortality increased from 570 (2.8 %) in 2016 to 803 (3.9 %) in 2020 (Ptrend = 0.001) while amputations increased from 1084 (33.2 %) in 2016 to 1995 (44.6 %) in 2020 (Ptrend<0.001). Mean LOS increased from 5.1 (SD 2.7) days in 2016 to 6.5 (SD 0.9) days in 2020 (Ptrend = 0.002). The mean THC for CLI increased from $50,873 to $69,262 in 2020 (Ptrend<0.001). The endovascular revascularization rates decreased from 11.5 % (525 cases) in 2016 to 10.7 % (635 cases) in 2020 (Ptrend = 0.025). Surgical revascularization rates also increased from 4.9 % (225 cases) in 2016 to 10.4 % (600 cases) in 2020 (Ptrend = 0.041). CONCLUSION: Hospitalization and outcomes for CLI worsened among young adults during the study period. There is an urgent need to enhance surveillance for risk factors of PAD in this age group.

3.
Cureus ; 16(2): e55241, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38558636

ABSTRACT

Atrial fibrillation (AF) represents a significant global public health concern, particularly due to its association with adverse health outcomes such as stroke and heart failure. In Nigeria, where the burden of cardiovascular diseases is rising, understanding the prevalence and impact of AF is crucial for effective healthcare planning and intervention strategies. This review examines the epidemiology of AF in Nigeria, comparing it with global and African data. It explores demographic and regional variations, comorbidity factors, and the impact of AF on the healthcare system, mortality, and quality of life. Notably, the prevalence of AF in Nigeria generally falls just under 5%, but this figure rises to approximately 9% in stroke patients and 11-20% among those with heart failure (HF). Rheumatic heart disease (RHD) is identified as a significant AF risk factor within Africa, affecting around 20% of AF patients - a stark contrast to the 2% in North America. AF's association with higher mortality rates and functional deterioration highlights the urgent need for improved diagnostic and therapeutic approaches, alongside broader public health measures. In conclusion, the review emphasises the significant public health concern AF represents in Nigeria, especially among HF and stroke patients, and stresses the importance of tailored healthcare policies and interventions to mitigate AF's impact and improve patient outcomes.

4.
Cureus ; 16(1): e52102, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38344627

ABSTRACT

In an era marked by increasing awareness of the detrimental effects of smoking on our health, the efficacy of smoking cessation strategies is of great significance. Numerous studies have demonstrated the effectiveness and success rates of various pharmacological and behavioral interventions, and different strategies have been proposed to optimize successful implementation. As we battle the global tobacco epidemic, it is important to better understand how to support individuals looking toward a smoke-free life. This review commences by highlighting the burden of smoking as a public health concern, exploring various smoking cessation interventions, and assessing their effectiveness and success rates. Our attention then shifts toward strategies for putting these interventions into action while highlighting challenges in implementation, ranging from individual to socioeconomic factors. Furthermore, this review sheds light on the need to tailor interventions to suit diverse populations, taking varying individual characteristics into account. We conclude this review by discussing future directions and emerging trends, considering the roles modern technology and policies can play in aiding smoking cessation.

5.
Cureus ; 15(11): e48421, 2023 Nov.
Article in English | MEDLINE | ID: mdl-38074047

ABSTRACT

This comprehensive review introduces the critical issue of venous thromboembolism (VTE), emphasizing its prevalence, particularly in developed countries, and its role as a leading cause of preventable deaths. It discusses the components of VTE, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), with a focus on the clinical challenges of diagnosing silent VTE in hospitalized patients. The review underscores the shocking statistics associated with VTE, including its impact on patient mortality, especially in medically treated, acutely ill patients. Despite the availability of evidence-based guidelines recommending VTE prophylaxis, there is a significant gap in implementation, making it a leading cause of unexpected hospital deaths. Additionally, the review outlines the multifaceted nature of VTE risk factors, ranging from transient to persistent and provoked to unprovoked, providing a comprehensive understanding of patient-specific considerations. The latter part of the review delves into the impact of VTE on patient health outcomes, revealing its adverse effects on survival, recurrence rates, and psychosocial well-being. Furthermore, it explores various preventive measures, including pharmacological and mechanical options, and their effectiveness, highlighting the importance of a multimodal approach. The review also touches on the challenges of guideline adherence and patient-centered considerations in VTE prevention.

6.
Cureus ; 15(9): e44692, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37809159

ABSTRACT

The Dietary Approach to Stop Hypertension (DASH) constitutes a nonpharmacological dietary strategy tailored with the primary objective of mitigating hypertension and averting its potential complications. Numerous clinical studies, such as the PREMIER trial, DASH sodium study, and OmniHeart trial, as well as other studies, substantiate the DASH diet's ability to manage hypertension. Beyond its profound impact on hypertension reduction, the DASH diet has exhibited notable efficacy in addressing an array of conditions such as heart failure, lipid homeostasis, dyslipidemia, and uric acid dysregulation. With its empirical foundation, the DASH diet emerges as an indispensable tool in the hypertension management toolkit, warranting its exploration and integration into various medical contexts. This review commences with an overview of both the DASH diet and the significance of hypertension as a prevailing health concern. The ensuing discussion meticulously examines the extensive body of clinical research, firmly establishing the DASH diet's prowess in hypertension management. Furthermore, this review delves into the strategic approaches necessary for the successful implementation of the DASH diet, outlining the roles of technology and governmental responsibilities in ensuring its widespread adoption. As a comprehensive examination of the DASH diet's efficacy and potential, this review underscores its significance in modern healthcare paradigms.

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