Introduction: Although "Life’s Essential 8" (LE8) is a key metric for cardiovascular health (CVH), its longitudinal association with subclinical atherosclerosis in Koreans remains unclear. We examined the association between baseline LE8 scores and the presence of coronary artery calcium (CAC). Methods: Data were obtained from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study, a prospective cohort (baseline: 2013–2018; follow-up: 2022–2024). Baseline CVH scores, comprising 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure), were categorized as low (0–<50), moderate (50–<80), and high (80–100). The main outcome was the presence of CAC at the follow-up. Multivariable logistic regression was used for statistical analysis. Results: During a mean follow-up of 7.3 years, among 1,746 participants (mean age: 52.3 years, 65.2% female), the overall prevalence of CAC was 41.4%, which decreased with increasing CVH scores (low: 64.6%, moderate: 41.5%, and high: 30.4%). Compared to the low CVH group, the fully adjusted odds ratios (95% confidence intervals) for the presence of CAC were 0.34 (0.23–0.51) in the moderate and 0.25 (0.15–0.39) in the high CVH group. Higher baseline CVH scores were log-linearly associated with lower odds of CAC presence, demonstrating a linear and dose-dependent relationship in the restricted cubic spline plot (p=0.102). The association between CVH and CAC was consistently observed across subgroups and sensitivity analyses. Conclusion: Our study showed that higher baseline CVH scores were associated with a lower risk of subsequent CAC, highlighting the importance of promoting ideal CVH early to reduce the burden of cardiovascular disease.
Introduction: DLL4-NOTCH1 signaling mediates juxtacrine communication between tip- and stalk-like endothelial cells during vascular sprouting, contributing to complementary aspects of endothelial function. Thus, simultaneous modulation of DLL4 and NOTCH1 may provide a strategy to broadly interfere with the endothelial functions involved in tumor angiogenesis. Accordingly, this study aimed to identify a novel natural compound capable of modulating DLL4-NOTCH1-mediated endothelial communication and to investigate how such modulation influences tumor angiogenesis and growth. Methods: We screened 66 natural compounds to identify those that suppress DLL4 and NOTCH1 signaling in endothelial cells. Using a dual-reporter system that combines a DLL4 promoter-driven reporter and a CSL luciferase reporter, we simultaneously assessed ligand-associated activity and downstream transcriptional output of the DLL4-NOTCH1 axis. We confirmed VEGF-induced target gene expression via Western blotting and quantitative real-time polymerase chain reaction. We further performed in vitro angiogenesis assays and in vivo Lewis lung carcinoma (LLC) allograft tumor experiments. Results: Among the 66 screened natural compounds, para-coumaric acid (p-CA) dose-dependently suppressed DLL4 transcription and NOTCH1 signaling activity in endothelial cells, with IC50 values of 4.57 and 8.34 µm, respectively. Furthermore, p-CA significantly suppressed VEGF-induced endothelial cell proliferation, migration, and tube formation. In the LLC allograft model, p-CA treatment suppressed tumor growth and vascular density, increased pericyte coverage, reduced tumor hypoxia, and enhanced CD3+ T-cell infiltration and tumor cell apoptosis. Conclusion: In summary, p-CA is a natural compound that functionally suppresses VEGF-driven DLL4-NOTCH1 signaling in endothelial cells, exhibiting strong anti-angiogenic effects and promoting functional vascular normalization, resulting in marked tumor suppression and enhanced antitumor immunity in vivo. These findings suggest that p-CA warrants further investigation as an anti-angiogenic compound for cancer therapy.
Introduction:Arterial stiffness, measured by brachial-ankle pulse wave velocity (baPWV), has been linked to diabetic peripheral neuropathy (DPN). However, the evidence regarding its association with large-nerve fiber dysfunction, specifically assessed by vibration perception threshold (VPT), in Chinese patients aged 18-65 years with type 2 diabetes mellitus (T2DM) is scarce. This study aimed to investigate the relationship between baPWV and VPT in this specific population. Methods:This cross-sectional study enrolled 600 inpatients with T2DM aged 18-65 years. baPWV was measured using an automated waveform analyzer. DPN was defined as a VPT ≥15 volts in at least one foot. Multivariable logistic regression models were used to assess independent association, expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline and subgroup analyses were performed to evaluate the dose-response relationship and consistency of the association. Results:Among the participants, 165 (27.5%) were classified into the abnormal VPT group. After full adjustment for confounders including age, gender, diabetes duration, glycated hemoglobin, and lifestyle factors, each 100 cm/s increase in baPWV was significantly associated with increased odds of DPN (OR = 1.07, 95% CI: 1.01-1.14). When analyzed by quartiles, participants in the highest baPWV quartile (≥1,660 cm/s) had 1.29-fold higher odds of abnormal VPT (OR = 1.29, 95% CI: 1.03-3.01) compared to those in the lowest quartile (<1,380 cm/s), with a significant trend across quartiles (p for trend = 0.005). A linear dose-response relationship was confirmed without evidence of a threshold effect. Subgroup analyses showed the association was consistent across different patient characteristics. Conclusion:Elevated baPWV is independently associated with higher odds of DPN measured by VPT in Chinese patients aged 18-65 years with type 2 diabetes. This linear relationship not only underscores the pivotal role of arterial stiffness in the pathogenesis of DPN but also positions baPWV as a valuable tool for early risk stratification in clinical practice.
Introduction:Conventional systolic blood pressure (SBP) indices, such as mean SBP or variability indices, fail to capture control consistency. SBP time in target range (TTR) improves risk prediction by measuring SBP control duration. However, it neglects the magnitude of SBP elevation, treating minor and severe elevations equally. We developed and validated the SBP burden, a novel metric integrating both the duration and magnitude of SBP elevation, to enhance cardiovascular risk prediction. Methods:This post hoc analysis of the SPRINT included 9,017 high-risk, nondiabetic participants (age, 67.0 [61.0-76.0] years; 64.7% men). SBP burden was calculated as the proportion of the over-target time multiplied by the over-target part proportion of SBP area under the curve [AUC] during that time, using SBP records in months 0-6 (target: 130 mm Hg). Its prediction performance was compared with mean SBP, SBP standard deviation (SD), SBP average real variability (ARV), SBP TTR, and SBP AUC. The primary outcome was the first occurrence of major adverse cardiovascular events (MACEs), including cardiovascular death (CVD death), myocardial infarction, stroke, and heart failure (HF) hospitalization. Results:Over a median follow-up of 3.89 years, 568 MACEs occurred. After adjusting for traditional risk co-variables, the SBP burden showed an independent linear association with MACEs (hazard ratio [HR], 95% confidence interval [CI]: 1.17, 1.09-1.26; p < 0.01) and this association remained even after further adjustment for SBP SD and ARV. Mean SBP (HR, 95% CI: 1.13, 1.03-1.23; p < 0.01), SBP SD (HR, 95% CI: 1.10, 1.01-1.19; p = 0.03), SBP ARV (HR, 95% CI: 1.10, 1.01-1.18; p = 0.02), SBP AUC (HR, 95% CI: 1.15, 1.05-1.26; p < 0.01), and SBP TTR (HR, 95% CI: 0.88, 0.80-0.97; p = 0.01) were also independent risk predictors. Further, we confirmed SBP burden acheived the greatest improvement in discrimination and reclassification (Net reclassification improvement as 0.12 [0.03-0.22]; integrated discrimination improvement as 0.0032 [0.0006-0.0076]), and feature importance (relative informativeness and LASSO ranking as top 1) among tested SBP indices. Conclusion:In high-risk, nondiabetic patients, SBP burden is an independent predictor of cardiovascular outcomes. It overcomes the limitations of SBP TTR, outperforming other SBP indices in predictive performance and feature importance for cardiovascular outcomes.
Introduction: The association between indices of arterial stiffness and/or pressure wave reflection with Alzheimer disease amyloid-β accumulation and tau pathology in the brain is unclear. Deficiency of estrogen post-menopause may be an important contributor to changes in these indices to affect Alzheimer’s disease progression. We aimed to assess the associations between indices of arterial stiffness and/or pressure wave reflection and the Alzheimer’s disease blood biomarker, p-tau217, in midlife women without dementia. Methods: This cross-sectional analysis of participants from the Integrated Women’s Health Program (IWHP) enrolled community-dwelling midlife women without dementia attending routine health screening at the National University Hospital in Singapore. Fasted blood p-tau217 was measured using the Simoa® ALZpath p-tau217 Advantage PLUS (Quanterix, MA, USA). Aortic augmentation index (AIx) and reflection index (RI) were obtained from peripheral arterial pressure waveforms and cardio-ankle vascular index (CAVI) measured using pressure cuffs on the extremities and a phonocardiogram. Multivariable linear regression was used to examine the independent associations between indices of arterial stiffness and serum levels of p-tau217. Results: Among 871 participants (mean age: 62.80 ± 6.02 years), every SD increase in AIx and RI scores was both associated with 0.010 pg/mL (95% CI: 0.003–0.017, p = 0.004) higher blood p-tau217 levels after adjustment for age, employment status, BMI, mild cognitive impairment, hypertension, cholesterol-HDL ratio, renal function, and ApoE4 carrier status. With natural logarithmic transformed p-tau217, RI remained significantly associated with ln(p-tau217), β = 0.026 (0.007, 0.045), p = 0.007, after covariate adjustment. For AIx, the association was attenuated but remained directionally consistent. Trends for the association between CAVI and blood p-tau217 level were not statistically significant after adjustment for covariates. Conclusion: Increases in indices of arterial stiffness and pressure wave reflection were associated with higher blood p-tau217 levels in community-dwelling midlife women without dementia. These indices may be markers of risk for tau-related pathologies in the brain.
Introduction: Biological rather than chronological age (C-age) drives deviation from healthy aging. This study aimed to identify a plasma metabolomic signature indicative of age-related cardiovascular risk (pMTB-age) predicting vascular morbidity and mortality. Methods: Nuclear magnetic resonance identified 38 plasma metabolites in two population cohorts: the Flemish cohort examined as discovery (N = 719 [2005–2010]) and internal replication cohort (N = 580/719 [2009–2013]) and the external replication Spanish Hortega cohort (N = 811 [2001]). Results: The trained model (pMTB-age), relating C-age to the plasma metabolome derived by elastic net regression, included 18 metabolites (six amino acids) and explained from 28.6% to 22.9% of C-age in the discovery and replication data. Feature importance of the retained metabolites derived by SHapley Additive exPlanation showed large interindividual variability in the relation between C-age and pMTB-age. In Flemish and Spanish, cardiovascular risk factors were significantly associated with C-age, pMTB-age, and pMTB-age uncorrelated from C-age (pMTB-age-R). In Flemish (median follow-up 12.3 years) and Spanish (18.8 years), mortality and cardiovascular complications correlated with C-age and pMTB-age. In Flemish, cardiac endpoints (hazard ratio [95% CI] 1.28 [1.00–1.63]) and its components kept significance in relation to pMTB-age-R. The pathway analysis revealed overrepresentation of glycine, serine, and threonine. Conclusions: pMTB-age is a multidimensional biomarker, which identifies individuals with accelerated vascular aging with high precision and combined with the pathway analysis highlights the role of amino acids in vascular disease. Therefore, pMTB-age can guide risk stratification and the personalized and timely prevention and treatment tailored to an individual’s unique pMTB-age profile.
Introduction: The cardio-ankle vascular index (CAVI) is a noninvasive indicator used to assess arterial stiffness and predict atherosclerotic cardiovascular disease (ASCVD). CAVI represents a scale-converted form of the stiffness parameter β. Both CAVI and β reflect overall arterial stiffness from the heart to the ankle. However, there are distinct mechanistic pathways underlying the heterogeneous progression of ASCVD across the arterial tree (e.g., elastic and muscular arteries). Thus, the present study aimed to (1) examine differences in segmental β between elastic and muscular arteries at rest; (2) compare these differences between young and older adults at rest; and (3) further compare them with the segmental β responses observed after exercise. Methods: Eighty-three healthy individuals aged 18–52 years were recruited and divided into two groups: the young group (18–23 years, n = 57) and the adult group (31–52 years, n = 26). Cuffs were applied to both upper arms, the left thigh, and the right ankle. Segmental β was measured at rest as well as immediately after exercise using the Master’s two-step exercise test. Results: At rest, muscular arterial stiffness (thigh-ankle β [taβ]) was 4.7 times higher in the young group and 2.8 times higher in the adult group, compared to that of the elastic arteries (heart-thigh β [htβ]). htβ and heart-ankle β (haβ) were higher in the adult group than in the young group (p < 0.05), whereas taβ was lower in the adult group (p < 0.05). After exercise, taβ, htβ, and haβ decreased in both groups. In the young group, exercise-induced β reduction was greatest in taβ, compared with htβ and haβ. This reduction was significantly greater in the young group than in the adult group (e.g., reduction in taβ was 4.9 times greater in the young group). Conclusion: This study demonstrated distinct segmental β values between elastic and muscular arteries, suggesting that the inherent stiffness of the arterial beds should ideally be assessed separately.
Introduction:Aortic wall calcification increases arterial stiffness which is often assessed by carotid-femoral pulse wave velocity (cfPWV). However, the impact of kidney function upon the association between calcification of the aortic wall and cfPWV remains unknown. Methods:To examine the association between aortic calcification and cfPWV, we prospectively recruited chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) and patients with normal renal function, planned for invasive coronary angiography. Participants underwent a non-contrast computed tomography scan of the entire aorta with subsequent Agatston scoring of the aortic wall in addition to a standardized cfPWV measurement and biochemical markers. Results:A total of 144 patients (67.1 ± 10.3 years, 24% female), of whom 110 had CKD (26 stage 3a, 33 stage 3b, 24 stage 4, and 27 stage 5), were included. Agatston score was associated with cfPWV in a univariate regression analysis (p < 0.001). So were age (p < 0.001) and diabetes (p = 0.001), but not gender, smoking status, eGFR, office systolic blood pressure, calcium-phosphate product, C-reactive protein nor vasodilator treatment. Multiple regression analysis including all these factors did not significantly change these associations and relative weight analysis revealed Agatston score to account for 30% of the variation in cfPWV in the model (total r 2 = 0.31). Conclusion:In a cohort representing the entire spectrum of kidney function, aortic Agatston score, as well as age and diabetes, were associated with cfPWV after adjustment for other risk factors including eGFR. However, most of the variation in cfPWV remains unexplained by these factors.
Introduction:Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity. Circulating endostatin is associated with both cardiovascular morbidity and impaired kidney function in the general population, but the utility of endostatin as a prognostic marker for CKD progression and mortality in patients with CKD is not well studied. The aim was to study association between serum endostatin and mortality, and also kidney function decline in a cohort of CKD patients (Salford Kidney Study [SKS]). Methods:Analyses were performed on baseline and annual follow-up samples from 970 adults in the SKS cohort with CKD stage 3-5. Association with mortality was studied using Cox proportional hazard models adjusted for age, gender, systolic and diastolic blood pressure, smoking status, diabetes mellitus, prior cardiovascular disease, creatinine-based estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (uPCR). Associations between endostatin and eGFR decline were studied with linear regression analyses. eGFR decline was defined as the percentage difference between baseline eGFR and follow-up eGFR (median follow-up, 6.2 years). Results:Median age of the cohort was 66 years, with a median eGFR of 30 mL/min/1.73 m2. Multivariate Cox regression models revealed an association between higher endostatin levels and mortality with adjustments for established cardiovascular risk factors (HR: 1.14; CI: 1.02-1.28; p = 0.02) but was attenuated and nonsignificant after adjustments for baseline eGFR and uPCR. Baseline levels of endostatin were associated with eGFR decline but were nonsignificant after adjustments for baseline eGFR and uPCR. Changes of endostatin concentrations during the study were significantly associated with eGFR decline in all models (regression coefficient 0.0023% decrease per month [95% confidence intervals 0.0012-0.0034, p < 0.001]). Conclusion:The clinical utility of plasma endostatin for risk prediction in CKD patients seems limited. Importantly, longitudinal changes of endostatin were significantly associated with eGFR decline. The clinical relevance of this warrants further studies.
Introduction:Age-related arterial remodeling is a key contributor to cardiovascular disease, but morphological changes in cerebral arteries with aging remain poorly characterized. We aimed to investigate age-related alterations in cerebral arterial morphology using quantitative analysis. Methods:This retrospective observational study analyzed brain magnetic resonance angiography images from 1,168 healthy individuals without cerebrovascular disease. An automated arterial measurement system was used to quantify morphological features, categorized into size metrics (e.g., area), shape metrics (e.g., minimum [min]-maximum [max] diameter ratio), and tortuosity metrics (e.g., curvature). Correlation analyses were performed between age and arterial features, and multivariable regression analyses were conducted to evaluate age-related effects across the entire cerebrovascular tree and individual cerebral arterial segments. Results:Luminal area increased steadily with age (rho = 0.217, p < 0.001). The min-max diameter ratio remained stable until the fifties and then increased rapidly after the fifth decade (rho = 0.144, p < 0.001), reflecting more circular vessel configurations. Curvature did not change significantly with age. Age was independently associated with the global features of cerebral arteries, including mean area (β = 0.285; 95% CI, 0.222-0.347) and mean min-max diameter ratio (β = 0.215; 95% CI, 0.147-0.282). At the level of individual artery analysis, the effect of age on luminal area was more pronounced in internal carotid arteries, whereas age-related changes in the min-max diameter ratio were more evident in medium-sized arteries, including the middle, anterior, and posterior cerebral arteries. Interaction analysis between age and vascular risk factors revealed a significant effect of interaction on arterial shape. Conclusions:Cerebral arteries show distinct age-related morphological alterations, characterized by luminal enlargement and greater circularity. These changes vary with arterial size and location, suggesting differential susceptibility of cerebral arteries to the effects of aging.
Introduction: Chronic kidney disease (CKD) raises cardiovascular risk, but its link with the cardio-ankle vascular index (CAVI) in diabetic and non-diabetic patients remains unclear. The aim of this study was to clarify the relationships between CAVI values and an aspect of renal function. Methods: We investigated the relationships among CAVI values, proteinuria, and the estimated glomerular filtration rate (eGFR) in 4,682 patients enrolled in a multicenter prospective coupling study (patients aged ≥30 years with at least one cardiovascular risk factor) and both eGFR and proteinuria data available. Based on vascular insufficiency guidelines, we classified the patients as having low (<8) or high (≥8) CAVI values. Results: The proteinuria positivity rate differed significantly between the low- and high-CAVI groups, and the difference was significant even after adjusting for age, gender, and other factors. Although direct comparisons showed a higher proportion of CKD (eGFR <60 mL/min/1.73 m2) in the high-CAVI group, this difference disappeared after adjustment. We further divided the low- and high-CAVI groups into diabetes mellitus (DM) and no diabetes mellitus (non-DM) subgroups to examine the rate of proteinuria positivity and the percentage of patients with eGFRs <60 mL/min/1.73 m2. After the multivariate analysis adjustment, the odds ratios for positive proteinuria the high-CAVI group were 1.69 (confidence interval [CI]: 1.08–2.63, p = 0.021) for the non-DM subgroup and 0.91 (95% CI: 0.56–1.47, p = 0.705) for the DM subgroup. The percentage of patients with eGFRs <60 mL/min/1.73 m2 was not significantly different between the low- and high-CAVI groups in both the DM and non-DM subgroups after the multivariate analysis adjustment (p = 0.088 for non-DM and p = 0.135 for DM). Conclusions: Proteinuria was associated with a CAVI ≥8 in patients without DM. High arterial stiffness may serve as a surrogate marker for renal damage in non-diabetic patients.
Introduction: Hypertension is linked to endothelial dysfunction, but causality and direction is not entirely known. The aim was to study the cross-sectional associations between home, office, and central BP and microcirculatory peak oxygen saturation (OxyP). Methods: In the observational Swedish CArdioPulmonary bioImage Study (SCAPIS) Linköping subsample, office and home BP were measured using an oscillometric device and OxyP was measured in forearm skin after a 5-min occlusion of the brachial artery. A linear regression was fitted to evaluate the mean change in OxyP per SD increase in BP. A logistic regression was fitted to evaluate the associations between BP above the median and OxyP below the median. Results: Of participants, 3,291 were included in the analyses. Per SD increase in systolic home BP, the adjusted mean (95% CI) difference in OxyP was −0.4 (−0.6 to −0.1%). In subgroup analyses, the association remained for women but not men, although the interaction by sex was not statistically significant. Also, in women but not in men, OxyP was lower in those with white coat hypertension vs. sustained normotension, i.e., mean (95% CI) 88.8 (88.2–89.4%) vs. 89.6 (89.3–90.0%), and in those with masked hypertension vs. sustained normotension, i.e., 87.5 (85.9–89.1%) vs. 89.6 (89.3–90.0%). Conclusion: Home BP, which better predicts cardiovascular disease than office BP, was inversely associated with OxyP. This correlation remained in subgroup analyses of women but not men, suggesting possible sex-dependent microcirculatory dysfunction or that masked hypertension could be a more important cardiovascular risk marker in women, despite its higher prevalence in men.
Metastasis to the thyroid gland from non-thyroid sites is an uncommon clinical presentation despite its rich blood supply. On the other hand, breast cancer frequently metastasizes to the bones, lungs, brain and liver, rather than thyroid gland which represents a rare target site for secondary disease. Metastasis to thyroid is clinically rare, with an incidence of 0.36% in all thyroid malignant tumors. We report the case of a 62-year-old woman with HER2-positive breast cancer, in whom lung and liver metastases were detected at initial diagnosis. Nearly four years later, follow-up imaging revealed a thyroid nodule, and ultrasound-guided core biopsy confirmed metastatic carcinoma consistent with the breast primary. With this breast cancer case with thyroid metastasis, we suggest that physicians involved in the follow-up care of breast cancer patients should consider a differential diagnosis of secondary thyroid malignancy when incidental lesions are diagnosed during radiological evaluations or local symptoms affect the cervical region, even many years after the diagnosis of primary cancer. Pulse Vol.17, 2025 P: 33-36
Background: BMT also known as Hematopoietic stem cell transplant (HSCT) is a curative treatment modality for many benign and malignant diseases. In Bangladesh, HSCT started from 2014 and till today only 6 centres are doing the procedure. Evercare hospital (previously known as Apollo hospital) is advanced among all of them and by 2023, completed 100 cases of HSCT starting from 2016. This retrospective study aims to analyse the outcome of first 100 transplants performed over 8 years (from 2016 to 2024) and data also compared with major transplant registries available worldwide. Results: Among these 100 patients, 61 cases were autologous SCT (auto-SCT) and 39 were allogeneic SCT (allo-SCT). Auto-SCT done mostly for Multiple myeloma and lymphoma. The median follow-up period was 18.6 months, overall survival (OS) was 72%, and disease-free survival (DFS) was 62.3%. Transplant-related mortality was seen in 2 (3.3%) patients, both due to relapse. Out of 39 allo-SCT patients, 27 were from matched sibling donors (MSD), and 12 from haploidentical (haplo) donors. The median follow-up period was 15 months, OS was 54%, and DFS 48.7%. The survival of MSD and Haplo-SCT patients were compared, for MSD at a median follow-up of 10.5 months, OS was 52% and DFS was 48.1%, and for Haplo-SCT at a median follow-up of 19.5 months, OS was 58.3% and DFS 50%. Conclusion: This survey provides real data about the current activities of HSCT from a tertiary care centre in Bangladesh and will help physicians to understand the challenges of transplant process and its complications. Pulse Vol.17, 2025 P: 6-14
The distribution pattern of ABO blood group and Rhesus-D type varies in different parts of the Bangladeshi population. This study was carried out to determine the frequency of ABO and RhD blood group among all the donors and patients both (OP and IP) attending Evercare Hospital Chattogram. Blood grouping has been conducted in the Department of Transfusion Medicine. Blood group reports of 7,226 donors and 14,866 inpatients (both OPD and IPD) were analyzed retrospectively, starting from April 2021 to March 2025. Blood grouping was performed by column agglutination technique using gel card and traditional hemagglutination technique using slide/tube test. Both forward and reverse typing was done to confirm ABO blood group, and Du test was performed to confirm RhD blood group when required. The most common ABO blood group was found to be O (36.8%) followed by B (30.7%), A (24.8%) and AB (7.8%). Regarding RhD type, RhD positive group was 96.6%, RhD negative 3.4% and Du positive 0.11% Pulse Vol.17, 2025 P: 19-22
Introduction: Blood transfusion is an integral part for managing transfusion dependent patients, surgical-gynecological emergencies and many other cases. Symmetry should be maintained between blood component requisition and utilization to ensure the optimization of blood transfusion service. Understanding the trend of proportion between demand and supply of blood component can set prediction for future. Optimum utilization of blood transfusion service will save time and laboratory resources. This study was conducted to evaluate the pattern of requesting and utilizing the blood components in a tertiary care hospital. Materials & method: It is a retrospective study. It was held in transfusion medicine and clinical hematology department of a tertiary care hospital from July to December 2024. Patient’s ID, blood request form and requested unit were kept under record. Simultaneously blood component units delivered for transfusion and units returned or not transfused were also recorded. Data were analyzed for cross match transfusion ratio (CT ratio), transfusion index (TI) and transfusion probability calculation (%T). Result: Over the six-month period 4,903 units of blood components were crossmatched for 4,454 patients. A total of 3,711 units were transfused to 3,035 patients. In this study C:T ratio was found 1.31, transfusion probability (%T) was 68.19 and transfusion index (TI) was 0.82 overall six months period. Analysis of the result of our study signifies appropriate use of blood units. Conclusion: Blood transfusion is a life-saving procedure for those with a genuine medical need. So, its use should always be under monitoring to prevent misuse of this valuable resource. Various transfusion indices like C:T ratio, %T and TI can be used as standard tools for ensuring appropriate use of blood. Persistent improvement in good transfusion practice can be achieved by continuous surveillance. Pulse Vol.17, 2025 P: 15-18
Background: Acute upper gastrointestinal bleeding is the most common gastrointestinal emergency, and the patients should undergo urgent endoscopy within 24 hours of presentation, especially when associated with significant comorbidity. Accurate endoscopic diagnosis and effective therapeutic intervention with full endoscopy set up is the key to success for rescuing the patients from life threatening situations. Case Presentation: A 65-year-old Bangladeshi male, admitted with acute myocardial infarction at Evercare Hospital Dhaka, suddenly started vomiting out of profuse amounts of fresh blood in Cardiac Cath Lab during Coronary intervention and was brought back to CCU. On urgent referral we took a full set of endoscope machines with necessary equipment to CCU. Owing to the possibility of aspiration of blood, a cardiac anesthetist did endotracheal intubation to seal the entry of airway. Endoscopic evaluation revealed a deep mucosal tear at lower esophagus, secondary to reflux. After irrigation with diluted epinephrine, four metallic clips were applied and hemostasis ensured. One more clip was applied to the remaining defect of the tear after 3 days at follow-up endoscopy. The patient fully recovered from GI bleeding and discharged in stable condition. Conclusion: This case demonstrates the life-saving potential of emergency endoscopic procedures in managing complex upper gastrointestinal bleeding. It also highlighted the importance of advanced skills, creativity and multidisciplinary expertise in overcoming procedural challenges. Pulse Vol.17, 2025 P: 41-43
Background: Squamous cell carcinoma (SCC) of the oral tongue commonly metastasizes to regional cervical lymph nodes, but distant skeletal metastases are exceedingly rare. Case Presentation: We report a 54-year-old male diagnosed with grade I SCC of the right lateral tongue with regional lymph node metastasis. Following surgical excision and neck dissection, the patient received concurrent chemoradiotherapy. Despite no locoregional recurrence during follow-up, the patient developed isolated bony metastasis to the right ischium ten months post-diagnosis. Histopathology confirmed poorly differentiated SCC at the metastatic site. Palliative radiotherapy and bisphosphonates led to symptomatic improvement. Conclusion: This case highlights the rare occurrence of bony metastasis in primary tongue carcinoma and emphasizes the importance of prolonged, vigilant follow-up and multidisciplinary care to detect and manage atypical disease progression. Pulse Vol.17, 2025 P: 37-40
Background: Prader-Willi syndrome (PWS) is a heterogeneous genetic disorder caused by an anomaly on the chromosome 15. This condition typically results in low muscle tone, reduced height, cognitive impairments, and persistent feelings of hunger, which can lead to severe obesity. Additional common challenges associated with PWS include disturbances in thermoregulation, arrhythmia, diabetes mellitus, and seizures. These multisystemic issues create unique challenges in anesthetic management, making thorough perioperative planning essential to minimize potential complications. Case Presentation: We present the case of a 19-year-old male with PWS who underwent laparoscopic hernioplasty and cholecystectomy under general anesthesia. The perioperative course was largely uneventful, with successful weaning from mechanical ventilation. The only notable occurrence was transient, intermittent hypertension during pneumoperitoneum, which was effectively managed without complications. Conclusion: Careful perioperative planning and multidisciplinary management enable safe anesthesia and favorable surgical outcomes in patients with Prader–Willi syndrome. Pulse Vol.17, 2025 P: 23-28
