Summary Polycystic ovary syndrome (PCOS) is a condition that affects fertility. There are two types of PCOS; the normal/lean type and overweight/obese type. The aim of this study was to assess baseline characteristics, ovarian response, quality of oocytes, embryos, pregnancy, implantation and live birth rates in normal/lean and overweight/obese patients with PCOS undergoing ICSI compared with patients without PCOS. This retrospective case–control analytical study included 38 normal/lean and 17 overweight/obese patients with PCOS, and 98 normal/lean and 17 overweight/obese patients without PCOS. Parameters were observed based on baseline characteristics, ovarian response to dosage and duration of gonadotropin administered, number of oocytes, matured oocytes, fertilization rate, embryo quality and development, pregnancy, implantation and live birth rates. Basal serum luteinizing hormone in normal/lean PCOS was significantly higher compared with non-PCOS groups. Total dosage of gonadotropin used was significantly lower in normal/lean PCOS compared with other groups. End estradiol levels in normal/lean PCOS was significantly higher compared with the non-PCOS groups. Number of follicles, retrieved oocytes and matured oocytes were significantly higher in PCOS groups compared with the non-PCOS groups. However, there were no differences in fertilized oocytes, cleavage, number of top-quality embryos, pregnancy, implantation, and live birth rates among groups. This present study suggests that normal/lean PCOS requires lower gonadotropin dosages and that patients with PCOS have more follicles and oocytes compared with patients without PCOS, however the number of fertilized oocytes and embryos from patients with PCOS were the same as those from patients without PCOS and suggested that the quality of retrieved oocytes in PCOS might be compromised.
Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13–1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09–1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73–3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32–4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33–3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05–0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.
Objectives: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage. Although hypertension is the most common comorbidity in COVID-19, the impact of BPV and therapeutic target of BPV to outcome in COVID-19 patients with hypertension remain unclear. The aim of this study is to investigate the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status,, and efficacy of antihypertensives in suppress hypertensive covid-19 patient's BPV. Design and method:This was a cohort retrospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups. Results:The mean age was 53.85 ± 18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR = 1.38; 95%CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95%CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had higher CRP (55.15 ± 50.80 vs 97.79 ± 77.17), higher creatinine cerum (1.80 ± 3.15 vs 0.91 ± 0.14) and high BPV status also significantly increased risk of mortality (HR = 2.30; 95%CI = 1.73-3,86; p = <0.001). Patients with combination of severe COVID-19 status, hypertension (+) and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95%CI = 2.32-4,97; p < 0.001) compared to other combination status of groups. In COVID-19 patients with hypertension, combination teraphy with CCB as well as CCB monoteraphy significantly decreased BPV (PR = 0.50; 95%CI = 0.27-0.93; p = 0.004) and mortality (HR = 0.17; 95%CI = 0.05-0.56; p = 0.004). Conclusions:High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.
Introduction:Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important.Objectives:To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients.Methods:We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve.Results:Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P < 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014).Conclusion:Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.
Background: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence. Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence. Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors.
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