Background: The Merit Wrapsody® Cell-Impermeable Endoprosthesis (CIE) is a self-expanding nitinol-based covered stent featuring a triple-layer polytetrafluoroethylene (PTFE) structure, originally designed for hemodialysis access dysfunction. Its combination of flexibility, radial force, and anti-restenotic properties renders it an attractive option for arterial reconstruction in complex anatomical settings. Experience with its use in peripheral arterial disease outside the dialysis context remains limited. Cases: We report two cases in which the Wrapsody® CIE was employed as an off-label device for complex iliac arterial reconstruction. Case 1 involved a 48-year-old man with chronic occlusion of a 19-year-old Dacron bypass graft and a 7-year-old drug-eluting stent causing disabling claudication, treated with mechanical thrombectomy and dual Wrapsody® covered stent implantation, with follow-up of 3 years and 11 months. Case 2 involved a 56-year-old woman with a longstanding iatrogenic iliac arteriovenous fistula secondary to lumbar spine surgery, definitively excluded using a bifurcated aortic endograft combined with a Wrapsody® covered stent as the contralateral iliac limb. Results: Both procedures achieved technical success. In Case 1, limb perfusion was fully restored, with an ankle-brachial index of 1.19 at 39-month follow-up. In Case 2, the arteriovenous fistula was completely excluded with rapid clinical improvement. At 10 months of follow-up, the endograft body remained well-positioned with the Wrapsody® limb patent in the right common iliac artery. The left iliac limb subsequently occluded; however, limb perfusion was maintained via collateral circulation, and fistula exclusion was durably achieved. Conclusion: These cases highlight the versatility of the Wrapsody® CIE as an unconventional endovascular tool for complex iliac pathologies, including chronic graft occlusion and arteriovenous fistula exclusion. Prospective data are required to define its role in peripheral arterial reconstruction.
Aim: To determine the characteristics of the course of chronic heart failure (CHF) against the background of rheumatoid arthritis (RA) by conducting a comparative analysis of laboratory, instrumental, and clinical indicators of CHF in patients with RA and those without RA, as well as to identify possible associations between basic anti‑inflammatory therapy and the parameters under study. Materials and Methods: The study included 256 patients (all study participants were women): the study group consisted of 134 patients with CHF and RA, and the comparison group consisted of 122 patients with CHF without RA. The functional class of CHF in the study groups was NYHA I–II. The diagnosis of CHF was made based on the current criteria. The diagnosis of RA was confirmed using laboratory and instrumental criteria. A comparative assessment of clinical and laboratory parameters was carried out in the study groups. An analysis was conducted of possible associations between basic anti‑inflammatory therapy for RA and indicators of the disease course. The paper presents statistically significant results. Data processing was carried out using the Statistica 10.0 software. The critical significance level for testing statistical hypotheses was p < 0.05. Results: The study showed that patients with RA have higher E/e ratios, blood pressure, and worse lipid profile and GFR values, which is likely associated with systemic inflammation. At the same time, the NT‑proBNP level turned out to be lower than in the comparison group. The comparison of therapies revealed that taking methotrexate (as opposed to leflunomide) helps to reduce the NT‑proBNP level, improve the E/e` ratio, and reduce symptoms of heart failure, which confirms the cardioprotective effect of methotrexate in RA. Conclusion: Taking methotrexate at a dosage of 15 mg/day may have a positive effect on such parameters as E/e` and NT-proBNP in patients with CHF and RA. However, prospective studies are needed to confirm this hypothesis.
Cardiac amyloidosis usually transpires when systemic amyloid gets deposited within the myocardial tissues, thus sparking the onset of restrictive cardiomyopathy. In this regard, there are two forms of cardiac amyloidosis namely amyloid light chain (ALC) amyloidosis caused by accumulation of immunoglobulin light chains and transthyretin amyloidosis instigated by deposition of transthyretin (ATTR) amyloid.
The article identifies the correlation (or associations) between body mass index (BMI) and brain stroke patients using 750 real study subjects including both normal and brain stroke individuals. The present outcomes have been obtained herein using joint statistical modeling. It is derived herein that mean BMI is negatively associated with the joint interaction effect (JIE) of age and hypertension (HYP) i.e., AGE*HYP (P=0.0040), age and heart disease (HRT) status i.e., AGE*HRT (P<0.0001), age and stroke (STR) i.e., AGE*STR (P=0.0013), HYP and smoking (SMO) status i.e., HYP*SMO (P=0.0102), while it is positively associated with the JIEs of residence type (RES) and STR i.e., RES*STR (P=0.0438), HYP and HRT i.e., HYP*HRT (P=0.0119) and HRT*STR (P=0.0493). In addition, mean BMI is positively associated with the JIE of glucose (GLU) levels and ever married (MAR) i.e., GLU*MAR (P=0.0232), GLU and work type (WOR) i.e., GLU*WOR (P=0.0312) and GLU*SMO (P=0.0383). Moreover, the variance of BMI is positively associated with the JIEs of RES*HYP (P = 0.0449), HRT*STR (P=0.0003), GLU*HYP (P=0.0504), SMO*HYP (P=0.1975), while it is negatively associated with the JIE of HRT*RES (P=0.0176). Also the variance of BMI is positively associated with GLU*HYP (P=0.0504), and it is negatively associated with GLU*GEN (P=0.2046). There are some more associations of BMI levels with some other factors for brain stroke patients in the both mean and variance models. These derived associations of BMI with heart and diabetes diseases factors, and also physical and lifestyle parameters may be helpful for the brain stroke patients, medical practitioners and researchers. In addition, care should be taken on BMI, glucose levels and smoking at older ages.
Fever pattern is helpful to diagnose the associated infection in Acute Rheumatic Fever. The gold standard for diagnosis of GAS (Group A streptococcus) pharyngitis is bacterial culture. However, throat culture takes 24 - 48 hours and requires culture facilities. Therefore, culture tests are difficult to use in primary care practice. To compensate for these shortcomings, a rapid antigen detection test (RADT) was developed to detect GAS within a few minutes without the need of laboratory facilities. The Korean upper respiratory tract infection guideline recommends that the RADT to be performed in patients with modfied Centor score of 3 or above. A rapid slide agglutination test (streptozyme, Carter Wallace test) that looks at antibodies against several (five) streptococcal extracellular antigens and it is thought to improve the detection of streptococcal infection. The coexistence of acute rheumatic fever with malarial infection is uncommon. Relapsing pattern of fever is the short febrile periods occurring between one or several days of normal temperature. Malaria, in particular that caused by infection with plasmodium vivax, produces relapsing fever at 48 hrs interval. The exact mechanism for acute rheumatic fever remains unexplained and ‘molecular mimicry’ appears to be most likely. Similarly for coexistence of acute rheumatic fever with malarial infection remains unexplained and related to ‘altered immune status’, particularly with P. vivax infection which may be related to specific duffy blood group antigen.
