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The study showed that among patients with CCS, chronic kidney disease (CKD) is associated with a higher syntax score (SS) and incomplete revascularization prevalence. Additionally, an association was observed between incomplete revascularization and an increased risk of MACE.

Atherosclerotic plaque formation in the epicardial coronary arteries is the pathological hallmark of coronary artery disease (CAD). Several clinical manifestations can be classified as either chronic coronary syndrome or acute coronary syndrome due to the dynamic nature of the CAD process.

Chronic kidney disease and coronary artery disease constitute a high-risk combination. Despite its high prevalence, few studies have been conducted on CAD, specifically in CKD patients, frequently excluded from most trials. Therefore, there is a lack of evidence for CAD management, which might lead to the inadequate treatment of CKD patients.

To fill this knowledge gap, Shereen Ibrahim Farag, Benha University, Faculty of Medicine, Cardiology Department, Benha, Egypt, and colleagues aimed to determine the impact of CKD on the completeness of revascularization and MACE in patients with chronic coronary syndrome.

The study enrolled 400 patients with CCS who underwent revascularization by PCI. They were categorized into two categories according to their estimated glomerular filtration rate (eGFR) levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.

Reclassification of the patients was done according to revascularization into complete and incomplete revascularization groups with a one-year follow-up to assess the MACE.

Based on the study, the researchers reported the following findings:

• CKD patients were significantly older (65.78 ± 6.41 versus 56.70 ± 9.20 years). They had higher contrast-induced nephropathy, syntax scores, all-cause mortality, heart failure, and MACE.
• After reclassification according to revascularization, GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 versus 65.67 ± 26.62, respectively).
• Repeated revascularization, stent thrombosis, STEMI, MACE, stroke, and all-cause mortality were more prevalent among patients with incomplete revascularization.
• Multivariate regression analysis revealed eGFR and SS as independent predictors of incomplete revascularization.
• The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity.

“The findings showed that chronic kidney disease is linked with a higher prevalence of syntax score and incomplete revascularization in CCS patients,” the researchers wrote.

“Incomplete revascularization is also related to a higher prevalence of MACE. As a result, CKD predicts incomplete revascularization and subsequent MACE in CCS patients,” they concluded.

Reference:

Farag, S. I., Mostafa, S. A., Kabil, H., & Elfaramawy, M. R. (2023). Chronic kidney disease’s impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome. Indian Heart Journal. https://doi.org/10.1016/j.ihj.2023.11.006

The study showed that in clinical practice, iron studies are under-measured, but iron deficiency is associated with severe heart failure and an increased risk of composite adverse events (CAE). The researchers suggested considering the need for iron replacement therapy in children who present with heart failure with DCM.”

“The study is the largest to date to evaluate iron status in pediatric DCM,” the researchers reported. “Almost two-thirds of patients who had iron studies measured were iron deficient, and this conferred an increased risk of the composite occurrence of mechanical circulatory support (MCS), death, or transplantation over time.”

They added, “Those who were iron deficient had a longer hospital stay and were more likely to be microcytic, anaemic, and hypochromic, with a higher NT-proBNP.”

Jack C. Luxford from Children’s Hospital at Westmead, Sydney, Australia, and colleagues aimed to determine the prevalence and impact of iron deficiency in children with dilated cardiomyopathy by conducting a retrospective single-centre cohort study.

For this purpose, the researchers conducted a retrospective single-centre review of all children between 2010 and 2020 with a DCM diagnosis and complete iron studies. Iron deficiency was defined as ≥2 of ferritin <20 μg/litre, transferrin >3 g/liter, iron <9 μmol/litre, or transferrin saturation (TSat) <15%. Laboratory and clinical and freedom from a composite adverse event of MCS, death, or transplant were compared between children with and without ID.

The study led to the following findings:

• Of 138 patients with DCM, 47 had available iron studies. 62% of patients were iron deficient.
• Children with ID were more likely to be receiving inotropes (17, 59%) or invasive/noninvasive ventilation (13, 45%) than those who were iron-replete.
• They had a higher incidence of anaemia (22, 76%) and higher NT-proBNP (1,590 pmol/litre).
• Children with ID had significantly less freedom from the CAE at 1 year (54% ± 10%), 2 years (45 ± 10), and 5 years (37% ± 11%) than those without.
• Iron deficiency and anaemia were the only significant predictors of the CAE on univariate Cox regression.

The findings revealed a high prevalence of ID in children with DCM.

“Iron studies are undermeasured in clinical practice, but ID is associated with severe heart failure and an increased CAE risk,” the researchers concluded. “The need for iron replacement therapy should be considered in children who present in HF with DCM.”

Reference:

Luxford, J. C., Casey, C. E., Roberts, P. A., & Irving, C. A. (2023). Iron deficiency and anemia in pediatric dilated cardiomyopathy are associated with clinical, biochemical, and hematological markers of severe disease and adverse outcomes. The Journal of Heart and Lung Transplantation. https://doi.org/10.1016/j.healun.2023.11.014

A study published in Frontiers in Public Health concluded that mindfulness therapy may reduce depression, anxiety, and stress in university students. Additionally, it may improve their sleep quality but not their mindfulness rating scores significantly. These findings emphasize mindfulness therapy’s effects on students’ moods.

This study estimated the effect of mindfulness therapy on mental health.

Two researchers conducted a meta-analysis of 12 databases to determine how mindfulness therapy impact depression. They searched relevant trials ( January 2018 to May 2023) and measured depression using different scales and scoring systems like Beck Depression Inventory (BDI), Patient Health Questionnaire-9 (PHQ-9), Quick Inventory of Depressive Symptomatology (QIDS), Patient-Reported Outcomes Measurement Information System (PROMIS), Hospital Anxiety and Depression Scale (HADS), and Depression Anxiety Stress Scales (DASS) and others. After screening, they included 11 randomized controlled trials involving 1,824 participants.

Key findings are:

• Studies demonstrated positive effects of mindfulness therapy on depression, anxiety, stress and sleep quality with SMD,−0.33, −0.35, −0.39, and −0.81, respectively.
• There was no significant difference in mindfulness between the mindfulness therapy and control groups, with an SMD of -0.12.

They added that future studies should evaluate the effectiveness of strategies to enhance mindfulness therapy adherence and fidelity in improving mental health outcomes.

It is crucial to develop a simple, economical, and effective intervention to address mental health issues among university students.

Study strengths include inclusion of studies from 12 global databases, representative sample, large sample size all of which lead to subgroup and sensitivity analysis.

Reference:

Zuo X et al.The efficacy of mindfulness-based interventions on mental health among university students: a systematic review and meta-analysis. Front Public Health. 2023 Nov 30;11:1259250. doi: 10.3389/fpubh.2023.1259250.

The researchers revealed urethral stenosis after radiotherapy to be a clinically complex entity with a broad scope of associated symptoms, including high rates of patient-reported incontinence, pain, sexual dysfunction, depression, and bowel dysfunction.

“This multi-focal nature combined with patient unawareness and often insidious presentation creates a uniquely challenging condition to treat,” the researchers wrote.

Patients with localized prostate cancer typically have a choice of curative options, either surgery (radical prostatectomy) or radiotherapy (external beam or brachytherapy). There is no clarity on which treatment provides superior outcomes for both preserved genitourinary (GU) function and cancer control.

Kennedy Dirk and Keith Rourke from the University of Alberta, Edmonton, Alberta, Canada, aimed to evaluate patient-reported QoL (PRQoL) in patients presenting with membranous urethral stenosis after prostate radiotherapy. Urethral stenosis is an under-reported complication following prostate radiotherapy with a particular deficiency in PRQoL.

For this purpose, the researchers retrospectively reviewed patients presenting with urethral stenosis after radiotherapy from 2004-2022. Patient-reported quality of life was evaluated via patient survey using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). The researchers identified 230 patients at a mean age of 67.7 years and a mean time to stricture diagnosis of 63.6 months post-radiotherapy.

The study led to the following findings:

• Of 87 patients completing the survey, 29.9% recalled being aware of urethral stenosis as a potential complication, and 51.7% had documentation of urethral stenosis as a potential complication.
• 33.5% of patients underwent urethroplasty, 59.6% repeat endoscopic treatment and 6.1% an indwelling catheter. 64.4% of patients reported urinary dysfunction as a “moderate” or “big” problem, 66.7% reported frequent or total incontinence, 64.4% required daily pad use and 50.6% reported incontinence as either a “moderate” or “big” problem.
• 85.0% reported poor or absent orgasmic dysfunction and 88.5% reported erections insufficient for sexual activity.
• 47.1% of patients reported rectal pain and 31.0% reported dysuria.
• Fatigue and depressive symptoms were reported by 60.9% and 41.4% of patients, respectively.

“The findings from this cohort of patients presenting with urethral stenosis after radiotherapy for localized prostate cancer showed the magnitude of side effects and global impact on PRQoL which has previously not been reported,” the researchers wrote.

“There is a broad scope of patient-reported symptoms spanning lower urinary tract symptoms, incontinence, bowel dysfunction, sexual dysfunction, and systemic effects,” they concluded.

Reference:

Dirk, K., & Rourke, K. (2023). Health-Related Quality of Life in Patients with Urethral Stenosis after Radiation Treatment for Prostate Cancer. Urology. https://doi.org/10.1016/j.urology.2023.10.041

According to a recent study published in STROKE, Higher omega-3 levels are linked to a lower risk of total and ischemic stroke; there is no association with hemorrhagic stroke.

The effect of marine omega-3 PUFAs on the risk of stroke remains unclear. This study investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic). The study design included 29 international prospective cohorts with 183,291 participants. Each site conducted de novo individual-level analyses. Harmonized data is centrally pooled and analyzed.

Key findings from the study are:

• Out of 183,291 participants, 10,561 strokes were observed, including 8,220 ischemic and 1,142 hemorrhagic strokes, during a median follow-up of 14.3 years.
• For eicosapentaenoic acid, comparing quintile 5 with quintile 1, total stroke incidence was 17% lower and ischemic stroke was 18% lower with HR 0.83 and 0.82, respectively.
• For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke and a 14% lower incidence of ischemic stroke with HR, 0.88 and 0.86, respectively.
• Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke.
• These associations were not modified by baseline AF history or prevalent CVD.

James H. O’Keefe said This analysis of prospective studies found that long-chain omega-3 PUFA levels were inversely associated with f total and ischemic stroke risk, but not with hemorrhagic stroke risk. Therefore, higher DHA and EPA intakes may lower the stroke risk.

Reference:

O’Keefe et al. Omega-3 blood levels and stroke risk: A pooled and harmonized analysis of 183 291 participants from 29 prospective studies. Stroke, 55(1), 50–58. https://doi.org/10.1161/strokeaha.123.044281