International Journal of Health and Clinical Research

Cardiac and Vascular Diseases in Patients with HIV with Review of the National Inpatient Sample Database from 2015 to 2020

Awanwosa Valentine Agho — Tue, 28 Oct 2025 00:00:00 +0000

Background: As people living with HIV (PLWH) experience increased life expectancy due to widespread use of antiretroviral therapy (ART), the burden of non-communicable diseases—especially cardiovascular diseases (CVDs)—has grown significantly. Emerging data suggests that PLWH are at higher risk for adverse cardiac and vascular events compared to the general population, even when virologically suppressed.
Objective: To assess the prevalence, trends, and predictors of major adverse cardiovascular events (MACE) among hospitalized HIV-positive adults in the United States using data from the National Inpatient Sample (2015–2020).
Methods: This retrospective observational study analyzed over 1.1 million hospitalizations of HIV-positive individuals aged >18 years. The primary outcome was MACE, defined as a composite of heart failure (HF), myocardial infarction (MI), and cerebrovascular accident (CVA). Secondary outcomes included length of hospital stay (LOS), in-hospital mortality, and demographic and clinical predictors of MACE. Multivariable logistic regression models were applied to determine independent predictors.
Results:
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PLWH accounted for 6.2% of all adult hospitalizations during the study period and were significantly younger (mean age: 49.9 vs. 57.9 years, p<0.001) and more likely to be Black (52.1%) or low-income (49.8%) compared to non-HIV individuals.
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The overall MACE prevalence among PLWH was 22.6%, with a statistically significant upward trend from 2016 to 2020 (p<0.001).
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Independent predictors of MACE included older age, hypertension, dyslipidemia, atrial fibrillation, chronic kidney disease, end-stage renal disease, and obesity.
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Mortality was disproportionately higher among racial and ethnic minorities (Black, Hispanic, Asian, and Native American patients), individuals on Medicaid or self-pay insurance, and those with MI, stroke, or ESRD.
Conclusions: PLWH face a markedly elevated burden of cardiovascular comorbidities and adverse outcomes, driven by both traditional risk factors and HIV-specific mechanisms. MACE prevalence is rising, underscoring the need for tailored cardiovascular risk mitigation strategies in HIV care. Sociodemographic disparities further compound clinical outcomes, highlighting the urgency for equitable health interventions.

To evaluate postoperative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy

Nair Furqan, Javed Ullah Chauhan, Mohammed Rayaz, Gourav Singh Saini — Thu, 09 Oct 2025 00:00:00 +0000

INTRODUCTION : Laparoscopic cholecystectomy is the gold standard treatment for gallstone disease. Laparoscopic cholecystectomy has rapidly replaced open cholecystectomy for treatment of patients with gall bladder disease especially cholelithiasis .METHODS: The present study was conducted to evaluate the postoperative shoulder tip pain in low pressure versus standard pressure pneumo peritoneum during laparoscopic cholecystectomyRESULTS : The use of low pressure laparoscopic cholecystectomy (LPLC) as compared to standard pressure laparoscopic cholecystectomy (SPLC) significantly decreases the frequency and intensity of postoperative shoulder tip pain. LPLC decreases the demand for postoperative analgesics, decreases postoperative hospital stay and hence improves the quality of life in the early stage of postoperative rehabilitation. CONCLUSION: On the basis of these results, the widespread use of low pressure pneumoperitoneum during laparoscopic cholecystectomy is recommended.

The Endotheliopathy of Sepsis: Vascular Dysfunction as a Therapeutic Target

Kalpana Kuntal, Nishtha Singh, Nidhi Bhatnagar — Thu, 09 Oct 2025 00:00:00 +0000

Background- Sepsis is responsible for nearly one in five deaths worldwide, yet no targeted therapy has improved survival. Increasing evidence identifies the vascular endothelium as the organising principle of sepsis pathophysiology, integrating inflammation, coagulation, and metabolic failure into a single cascade of glycocalyx shedding, junctional disruption, coagulation imbalance, and immunothrombosis. Methods- These lesions underpin haemodynamic incoherence, acute respiratory distress syndrome, acute kidney injury, disseminated intravascular coagulation, and the long-term sequelae of post-sepsis syndrome. Circulating and urinary biomarkers—including syndecan-1, angiopoietin-2, soluble thrombomodulin, and glycosaminoglycans—mirror the extent of endothelial injury and provide translational anchors, yet remain underused in clinical classification and trial design. Result- Most vascular-targeted therapies, such as albumin, antithrombin, recombinant thrombomodulin, vitamin C, and statins, have failed to improve outcomes, largely due to unselected enrolment, delayed intervention, and reliance on crude mortality endpoints. Emerging strategies, including Tie2 agonists, angiopoietin-2 antagonists, and glycocalyx protectants, show promise but require biomarker-guided, adaptive evaluation. Reframing sepsis as endothelial failure offers a unifying paradigm for risk stratification, trial enrichment, and therapeutic innovation. Conclusion- To reduce the global burden, future strategies must be endotype-specific, mechanistically informed, and feasible across both high- and low-resource health systems.