Objective: To examine the impact of trimetazidine on skeletal muscle function in patients suffering from peripheral artery disease. Method: The systematic review was conducted from July 20 to November 22, 2022, in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis and comprised search for interventional studies on MEDLINE, ProQuest, Scopus and ScienceDirect databases using key words “peripheral artery disease” and “trimetazidine” or their synonyms. The cut-off date for the search was July 21, 2022. Clinical parameters, including Ankle-Brachial Index, Maximum Walking Distance, Maximum Walking Time and Pain Onset Time, were analysed both narratively and quantitatively whenever possible. Results: Of the 587 studies initially identified, 12(2%) were shortlisted. Of them, 2(16.7%) qualified for detailed analysis, comprising 172 patients with intermittent claudication. There was no significant difference between the examined groups' Ankle-Brachial Index values at baseline and post-intervention (p=0.83). Maximum Walking Distance improvement was significantly higher (p=0.0006) in trimetazidine group compared to control group. Maximum Walking Time MWT and Pain Onset Time were significantly different between control and trimetazidine groups (p<0.05). Conclusion: Trimetazidine's anti-ischaemic effect in peripheral artery disease patients improved Maximum Walking Distance, while it had no significant influence on Ankle-Brachial Index. Well-designed studies addressing the issue are needed. Key Words: Trimetazidine, Coronary, Ankle, Arterial disease, Muscle, Skeletal, Walking.

Hypertension is still one of the leading causes of morbidity and mortality globally. Complications of hypertension cause innumerable social, economic, and health cost burdens, reaching 131 million dollars per year in the United States. However, blood pressure control through lifestyle modifications and pharmacological intervention, achieving blood pressure targets is often unsatisfying. With its simple, cost-efficient, multifunctional, and enormous coverage characteristics, social media is promising to be utilized in health programs. Social media could provide massive information and accommodate the hypertension community to increase hypertension awareness. Incorporating social media in hypertension management improves patients’ lifestyles and pharmacological adherence more than conventional methods. The exact mechanism of how social media-based health programs increase treatment adherence is complex and has not been well-defined; raised awareness, bidirectional communication, and a qualified coach (physician) seem to be the essential factors. It should also be well aware that screen time duration and emotional alteration due to social media exposure could also potentially increase blood pressure. Hipertensi masih menjadi salah satu penyebab utama morbiditas dan mortalitas global. Komplikasi hipertensi menimbulkan beban sosial, ekonomi, dan biaya kesehatan yang mencapai 131 juta dollar setiap tahun di Amerika Serikat. Kontrol tekanan darah melalui modifikasi gaya hidup dan intevensi farmakologis, hasilnya seringkali masih belum memuaskan. Media sosial dengan karakteristiknya yang simpel, murah, multifungsi, dengan cakupan sangat luas tampak menjanjikan untuk digunakan dalam program-program kesehatan. Media sosial dapat menyediakan berbagai informasi dan mengakomodasi komunitas untuk meningkatkan kesadaran terhadap hipertensi. Penggunaan media sosial dalam manajemen hipertensi tampak mampu memperbaiki pola hidup dan ketaatan farmakologi lebih baik daripada metode konvensional. Mekanisme pastinya bersifat kompleks dan masih belum dapat dijelaskan dengan baik; namun peningkatan kesadaraan, komunikasi dua arah, dan pendamping (dokter) terkualifikasi tampak sebagai faktor-faktor penting. Hal yang seharusnya juga diperhatikan adalah durasi screen time dan perubahan emosional karena saat menggunakan media sosial juga dapat berpotensi meningkatkan tekanan darah.

Acute limb ischemia (ALI) is associated with a high risk of limb loss and mortality, even after surgical intervention. Recent findings suggest the beneficial role of the neutrophil-to-lymphocyte ratio (NLR) in predicting limb amputation and mortality in ALI patients. This current study aims to evaluate the role of NLR in predicting all-cause mortality (ACM) and amputations due to vascular events in patients with ALI. A systematic literature search was conducted across several databases. Meta-analysis with a random-effects model was used to quantitatively estimate the pooled odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while a bivariate meta-analysis was used to generate the summary receiver operating characteristic (ROC) curve. Five observational studies met predefined criteria. Patients with high NLR had a 7.5 times higher risk of 30-d and a 3.4 times higher risk of 2-y amputation compared to those with low NLR. The pooled sensitivity for 30-d and 2-y amputation was 81.3% and 71.0%, while the pooled specificity was 73.8% and 63.5%, respectively. For 30-d ACM, patients with high NLR had a nine times higher risk, while the risk was 1.5 times higher for 2-y ACM. The pooled sensitivity for predicting 30-d and 2-y ACM was 81.5% and 58.8%, with pooled specificity of 76.0% and 59.3%, respectively. NLR is a valuable predictor of short-term outcomes in patients with ALI, with higher predictive performance for 30-d amputation and ACM compared to 2-y outcomes. Its simplicity and availability make it a valuable tool in emergency settings.

To evaluate the impact of perioperative blood pressure variability (BPV) on cardiovascular outcomes and mortality in cardiac surgery patients. Literature searches were performed across scientific databases up to December 31, 2024. Studies reporting perioperative BPV in patients undergoing cardiac surgery and its association with mortality and clinical outcomes were included. Fifteen studies with 16,407 patients were included. Increased BPV was significantly associated with higher rates of 30-day mortality, acute kidney injury (AKI), prolonged intensive care unit stay, and cognitive dysfunction. Among patients with fewer comorbidities and perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001). Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in blood pressure (BP) standard deviation (SD) and a 15% increased incidence of postoperative delirium. The findings emphasize the critical need for precise perioperative BP control, with advanced metrics like BP fragmentation providing valuable insights into patient risk. Perioperative BPV appears to be a crucial factor influencing postoperative outcomes in cardiac surgery patients. Effective management of BPV may help reduce complications and improve patient outcomes, highlighting the potential benefits of tailored hemodynamic strategies. However, further research is needed to establish standardized BPV thresholds and optimal management approaches.

Objectives To present the EQ-5D utility score in outpatients with chronic and acute diseases and investigate the factors that affect HRQoL in outpatients in three government hospitals in Parigi Moutong District, Central Sulawesi, Indonesia. Methods We gathered two primary types of data: clinical conditions from hospital databases and sociodemographic information gathered through participant interviews. We used the EQ-5D index score quintiles as the dependent variable in an ordinal regression analysis to look at the multivariate relationships between the socioeconomic characteristics of the participants and their clinical conditions. Results The median EQ-5D index score of Indonesian outpatients was 1.00 [0.88–1.00]. Mobility and pain/discomfort dimensions are the most frequently reported problems, particularly among participant complaints relating to joints and extremities. Moreover, living in rural regions, retirement age, being female, and having a divorced marital status are sociodemographic variables linked to decreased EQ-5D index scores. Reported issues, particularly in the areas of self-care and activities, increase with the use of herbal medication. Conclusion Our study provides estimates of outpatient EQ-5D index scores applicable for pharmacoeconomic analysis. Outpatients with certain conditions, especially those with impaired mobility and pain, need special attention.

Objectives: Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by mutations affecting collagen and extracellular matrix proteins. Vascular EDS (vEDS) stands out for its severe prognosis due to the heightened risk of arterial and organ rupture which significantly increase mortality rates. Limited strategies for treating vEDS are prompting exploration for alternatives such as celiprolol, a cardioselective beta-blocker with potential to reduce vascular stress and improve collagen integrity. This review aims to evaluate current evidence on the impact of celiprolol in managing vEDS. Methods: A comprehensive literature search was conducted across scientific databases for studies comparing celiprolol with placebo or other treatments, focusing on relevant outcomes. Results: A total of 323 participants were included across studies published from 2010 to 2023, primarily conducted in European settings. Celiprolol administration, starting at 100 mg daily and titrated up to 400 mg, significantly reduced the incidence of major vascular events such as arterial dissections and ruptures. Most studies reported improved survival rates and fewer hospitalizations due to acute arterial events. Variations in treatment response and side effects such as dizziness and hypotension were noted across studies, occasionally leading to treatment. Conclusions: Celiprolol appears to be a promising treatment for reducing vascular events in vEDS patients, potentially improving quality of life and mitigating the substantial morbidity and mortality associated with vEDS. Future research should focus on refining treatment protocols, exploring mechanisms of action, and establishing comprehensive clinical guidelines to optimize patient outcomes.