RESUMO
Background: Rapid and accurate acute ischemic stroke (AIS) diagnosis is needed to expedite emergent thrombolytic and mechanical thrombectomy treatment. Changes in blood-based protein biomarkers during the first 24 h of AIS, the time window for treatment, could complement imaging techniques and facilitate rapid diagnosis and treatment. Methods: We performed a systematic review according to PRISMA guidelines. MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched for eligible studies comparing levels of blood-based protein biomarkers in AIS patients with levels in healthy controls and stroke mimics. Protein biomarkers from the following pathophysiological categories were included: neurovascular inflammation (MMP-9, TNF-alpha), endothelial integrity (VCAM-1, ICAM-1), cell migration (E-Selectin, P-Selectin, L-Selectin), markers of glial and neuronal origin (GFAP, S100, S100B, NSE), and cardiac dysfunction (BNP, NT-proBNP). The literature search was limited to English-language publications before November 7th, 2023. Results: A total of 61 studies from 20 different countries were identified, which included in total, 4,644 AIS patients, 2,242 stroke mimics, and 2,777 controls. Studies investigating TNF-alpha, MMP-9, VCAM-1, ICAM-1, E-Selectin, L-Selectin, GFAP, NSE, and S100B showed pronounced methodological heterogeneity, making between-study comparisons difficult. However, in 80% of NT-proBNP and BNP studies, and all P-selectin studies, higher biomarker levels were observed in AIS patients compared to healthy controls and/or patients with stroke mimics. Conclusion: None of the biomarkers included showed sufficient evidence for additional diagnostic benefit for AIS. Comprehensive standardized global multicenter studies are needed to (1) permit comparability, (2) enable valid statements about protein-based biomarkers, and (3) reflect real-world scenarios.
RESUMO
Hypertension (HTN) is a leading modifiable risk factor for multiple diseases. It has reached epidemic proportions, affecting nearly a third of the world's population. With such a high prevalence and an exhaustive list of potential complications, antihypertensive therapy has been a subject of focus for the scientific community for a long time. Recently, Dietary fiber is emerging as yet another promising candidate addressing this issue. It is a well-known fact that dietary modification alone can significantly impact a patient's health, with a noticeable effect on BP as well. But simply switching to healthy alternatives is not enough and must happen in tandem with dietary supplementation. The consumption of ultra-processed food has only increased in recent times. Hence, we feel the need to focus on dietary interventions in managing hypertension. This review aims to bring to light the current literature on the pathophysiology, risk factors, and treatment protocols of hypertension, focusing on dietary fibers and their role in hypertension management.
