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PALA, ARDA AYBARS, and YUSUF SALIM URCUN. "Is the Mean Platelet Volume a Predictive Factor for Atrial Fibrillation Developing After Coronary Artery Bypass Grafting in Elderly Patients?" Heart Surgery Forum 23, no. 6 (November 2, 2020): E809—E814. http://dx.doi.org/10.1532/hsf.3201.
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Background: Postoperative atrial fibrillation (PoAF) is the most common arrhythmic complication detected after coronary artery bypass grafting (CABG). It is associated with increased morbidity and mortality, especially in elderly patients. Mean platelet volume (MPV) shows the activation of platelets effective in the inflammatory and thrombotic process. The purpose of the present study was to investigate the relations between the preoperative MPV levels and development of PoAF in isolated CABG in elderly patients. Methods: A total of 103 elderly patients (aged ≥ 65 years), who underwent isolated CABG and were at preoperative sinus rhythm, were included in the study. Patients who did not have PoAF were identified as Group 1 (N = 74), and those with PoAF were identified as Group 2 (N = 29). Results: PoAF incidence was 28.2%. Preoperative MPV level was 8.41 ± 1.13 fL in Group 1, and 9.28 ± 1.00 fL in Group 2. The difference was statistically significant (P < .001). Multivariate logistic regression analysis revealed that age, preoperative hemoglobin, and preoperative MPV were independent predictive factors for PoAF development (OR [odds ratio]: 1.149, 95% CI [confidence interval]: 1.043-1.265, P = .005; OR: 1.334, 95% CI: 1.013-1.758, P = .040; OR: 2.103, 95% CI: 1.324-3.339, P = .002, respectively). The cut-off value for MPV as the predictor of PoAF development was found to be 8.43 (sensitivity: 82.8% and specificity: 55.4%). Conclusion: This study showed that MPV levels are associated with PoAF development in elderly patients, and other independent predictive factors include age and preoperative hemoglobin levels for POAF development.
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Gascoyne, S. C., and C. M. Hawkey. "Patterns of variation in vertebrate haematology." Clinical Hemorheology and Microcirculation 12, no. 5 (1992): 627–37. http://dx.doi.org/10.3233/ch-1992-12501.
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Onnelly, James G. D., and Phillip A. Isotalo. "Occurrence of hyperhomocysteinaemia in cardiovascular, haematology and nephrology patients: contribution of folate." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 37, no. 3 (May 1, 2000): 304–12. http://dx.doi.org/10.1258/0004563001899447.
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We investigated the contribution of plasma folate deficiency to hyperhomocysteinaemia in selected patient groups. Based on our observations, we have determined a lower folate reference interval cut-off using homocysteine as a metabolic marker of folate deficiency. Four hundred and twenty-five consecutive plasma specimens from cardiology ( n=120), haematology ( n=190) and nephrology ( n=115) patients were analysed for homocysteine and plasma folate concentrations. Healthy volunteers were used as controls ( n=117). We observed elevated homocysteine values above our upper reference limit of 13 µmol/L in 20·1%, 28·4% and 74·8% of the cardiology, haematology and nephrology patients, respectively. All but 1·9% of the patients had plasma folate values greater than the lower reference interval limit (3·4 nmol/L) for our folate assay. The percentage of patients from cardiology and haematology clinics who were hyperhomocysteinaemic and had folate values > 15 nmol/L was 5·0% and 4·2% , respectively. In contrast, 58% of our nephrology patients with folate values > 15 nmol/L were hyperhomocysteinaemic. In all three groups, an inverse relationship was found between folate and homocysteine. The folate/homocysteine ratios in the patient groups were approximately one-third of the values observed in our control group. Folate deficiency appears to be the primary cause of hyperhomocysteinaemia in our cardiology and thrombosis patients. However, severe folate deficiency appears to be uncommon. The majority of our nephrology patients are hyperhomocysteinaemic without an apparent folate deficiency. We conclude that raising the lower reference interval cut-off for folate to 15 nmol/L would help to identify individuals at risk for hyperhomocysteinaemia in our non-uraemic patient population. Increasing folate supplementation to maintain a plasma concentration above 15 nmol/L in cardiac, thrombosis and renal patients would greatly reduce the occurrence of hyperhomocysteinaemia in these patients.
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Cagli, Kerim, Hikmet Selcuk Gedik, Kemal Korkmaz, Baran Budak, Umit Yener, and Gokhan Lafci. "Transventricular Mitral Valve Repair in Patients with Acute Forms of Ischemic Mitral Regurgitation." Texas Heart Institute Journal 41, no. 3 (June 1, 2014): 312–15. http://dx.doi.org/10.14503/thij-13-3201.
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Transventricular mitral valve surgery combined with left ventricular restoration avoids atriotomy and provides a larger operative field. We describe a series of 5 patients in whom we performed transventricular mitral valve repair by various techniques, such as band annuloplasty, papillary muscle reattachment, chordal cutting, and edge-to-edge repair. The more acute forms of ischemic mitral regurgitation, as found in our patients, can coexist with post-myocardial infarction contained rupture or post-myocardial infarction ventricular septal rupture. Because these patients already have an indication for ventriculotomy, concomitant transventricular repair of the mitral valve can render a separate atriotomy unnecessary and thereby shorten the duration of cardiopulmonary bypass. Moreover, in patients with acute presentations, the absence of atrial dilation (this last associated with chronic cases) might make transventricular repair a better choice than the more difficult atrial approach.
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Dey, Joydeep, and Sunil Karforma. "Unsynchronized Ann & Genetics Guided Telecardiology Security Reinforcement in the Light of Covid-19." Journal of Mathematical Sciences & Computational Mathematics 3, no. 2 (January 3, 2022): 142–55. http://dx.doi.org/10.15864/jmscm.3201.
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In this COVID-19 crucial stage, cryptographic developments help to convey secret information inside the digital telemedicine frameworks. The novel corona virus had broken all configurations of our life. In the clinical medical sciences, patients are encouraged to select the remote based telemedicine services. Cardiac patients are especially defenseless to this COVID-19. Patients having Chronic Obstructive Pulmonary Diseases (COPDs) as co-morbidity are enthusiastically prescribed to remain protected at their remote isolations. Through such telecardiology, they might impart their basic data with various cardiovascular experts. This will diminish their odds of getting COVID-19 positive because of no actual developments outside homes. Patients experiencing such significant COPDs are to be analyzed and treated appropriately via cardiologists. Contemporary imperfections on patients' private data are an open challenge in such telecardiology. Electronic cardiac data are very much vulnerable in nature. Along these lines, it is exceptionally critical to force a high level security strategy in such COVID-19 telecardiology. In this paper, we have generated session key based on unsynchronized artificial neural networks and genetic algorithm. Two unsynchronized ANNs were considered to have two intermediate keys. These keys were genetically crossover to form the session key. Furthermore, that session key would e used in the secret share generation process. Entropy values observed with respect to the secret share were nearly closed to eight. Histogram, floating frequency, and autocorrelation, etc were generated by the proposed technique with well-distributed in shapes. The functional time in the form of encryption and decryption were evaluated in this paper for different secret shares. Patients' medical data are very much under severe risk of intrusion. Lastly, secret shares were transmitted through RSA. This framework acts against various security conducts in correspondence network particularly where online clinical exchanges have overflowed colossally in this COVID-19 period.
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Pimanda, John, Harry Lowe, Philip Hogg, Colin Chesterman, and Levon Khachigian. "Novel and Emerging Therapies in Cardiology and Haematology." Current Drug Target -Cardiovascular & Hematological Disorders 3, no. 2 (June 1, 2003): 101–23. http://dx.doi.org/10.2174/1568006033481465.
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Parrella, Antonio, Arcangelo Iannuzzi, Mario Annunziata, Giuseppe Covetti, Raimondo Cavallaro, Emilio Aliberti, Elena Tortori, and Gabriella Iannuzzo. "Haematological Drugs Affecting Lipid Metabolism and Vascular Health." Biomedicines 10, no. 8 (August 10, 2022): 1935. http://dx.doi.org/10.3390/biomedicines10081935.
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Many drugs affect lipid metabolism and have side effects which promote atherosclerosis. The prevalence of cancer-therapy-related cardiovascular (CV) disease is increasing due to development of new drugs and improved survival of patients: cardio-oncology is a new field of interest and research. Moreover, drugs used in transplanted patients frequently have metabolic implications. Increasingly, internists, lipidologists, and angiologists are being consulted by haematologists for side effects on metabolism (especially lipid metabolism) and arterial circulation caused by drugs used in haematology. The purpose of this article is to review the main drugs used in haematology with side effects on lipid metabolism and atherosclerosis, detailing their mechanisms of action and suggesting the most effective therapies.
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Kallenbach, Klaus, and Matthias Karck. "Perkutaner Aortenklappenersatz – Kontra." Herz Kardiovaskuläre Erkrankungen 34, no. 2 (March 2009): 130–39. http://dx.doi.org/10.1007/s00059-009-3201-1.
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Chong, Ji Y., and Ralph L. Sacco. "Epidemiology of Stroke in Young Adults: Race/Ethnic Differences." Journal of Thrombosis and Thrombolysis 20, no. 2 (October 2005): 77–83. http://dx.doi.org/10.1007/s11239-005-3201-9.
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Gosselin, Robert C., Dorothy Adcock, Akbar Dorgalaleh, Emmanuel J. Favaloro, Giuseppe Lippi, João M. Pego, Irene Regan, and Virginie Siguret. "International Council for Standardization in Haematology Recommendations for Hemostasis Critical Values, Tests, and Reporting." Seminars in Thrombosis and Hemostasis 46, no. 04 (October 22, 2019): 398–409. http://dx.doi.org/10.1055/s-0039-1697677.
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AbstractThis guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to provide laboratory guidance for (1) identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, (2) critical result thresholds, (3) acceptable reporting and documenting mechanisms, and (4) developing laboratory policies. The basis for these recommendations was derived from published data, expert opinion, and good laboratory practice. The committee realizes that regional and local regulations, institutional stakeholders (e.g., physicians, laboratory personnel, hospital managers), and patient types (e.g., adults, pediatric, surgical) will be additional confounders for a given laboratory in generating a critical test list, critical value thresholds, and policy. Nevertheless, we expect this guidance document will be helpful as a framework for local practice.
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Cui, Guanglin, Zongzhe Li, Rui Li, Jin Huang, Haoran Wang, Lina Zhang, Hu Ding, and Dao Wen Wang. "A Functional Variant in APOA5/A4/C3/A1 Gene Cluster Contributes to Elevated Triglycerides and Severity of CAD by Interfering With MicroRNA 3201 Binding Efficiency." Journal of the American College of Cardiology 64, no. 3 (July 2014): 267–77. http://dx.doi.org/10.1016/j.jacc.2014.03.050.
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Fincham, J. E., M. Faber, M. J. Weight, D. Labadarios, J. J. F. Taljaard, J. G. Steytler, P. Jacobs, and D. Kritchevsky. "Diets realistic for westernised people significantly effect lipoproteins, calcium, zinc, vitamins C, E, B6 and haematology in Vervet monkeys." Atherosclerosis 66, no. 3 (August 1987): 191–203. http://dx.doi.org/10.1016/0021-9150(87)90063-3.
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Shamratova, Aliya R., Valentina G. Shamratova, Aliya F. Kayumovа, and Klara R. Ziyakaeva. "The Capabilities of Haematology Analysers for Assessing the Bodyʼs Physiological and Pathological Conditions (Review)." Journal of Medical and Biological Research, no. 1 (February 10, 2021): 89–101. http://dx.doi.org/10.37482/2687-1491-z047.
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Haematology analysers have become an intrinsic part of contemporary medical practice and are used by specialists in various fields of medicine to diagnose diseases and predict their course and outcome. Moreover, the readings of these devices are currently in demand in experimental biology and medicine, toxicology, and veterinary medicine. This review examines the capabilities of modern models of haematology analysers and prospects for their use. New technical approaches combined with already known methods and statistical calculation parameters allow us to significantly expand the range of analyser output. It is shown that the introduction of programs for statistical calculations of a large number of indices and parameters of the distribution of cell populations by their volumes opens up new prospects for describing and evaluating not only pathological, but also physiological states of the body. We analysed both Russian and foreign literature on the use of erythrocyte and platelet indices to diagnose cardiovascular and other pathologies. Taking into account the indicators of corpuscular volume based on histograms and analysing statistical parameters of blood cell distribution enhance our understanding of the structure of blood cell populations, significantly increase the information content of research and can serve as an additional criterion for quantitative assessment of the bodyʼs conditions and diagnosis of diseases. Statistical characteristics such as asymmetry coefficient, kurtosis, and standard deviation of empirical erythrograms and leukograms allow us to assess the degree of anisocytosis and cellular heterogeneity, as well as the ratio of different populations. Studying the volume characteristics of blood cells based on histogram analysis significantly improves the effectiveness of using haematology analysers in evaluating various pathological and physiological conditions of the body.
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Patterson, Andrew J., Andrew J. Degnan, Stewart R. Walsh, Mohammed Eltayeb, Earl F. Scout, James M. F. Clarke, Yvonne G. Wilson, and Tjun Y. Tang. "Efficacy of VBHOM to Predict Outcome Following Major Lower Limb Amputation." Vascular and Endovascular Surgery 46, no. 5 (May 15, 2012): 369–73. http://dx.doi.org/10.1177/1538574412445600.
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Purpose: This study tests an existing Vascular Biochemistry and Haematology Outcome Model (VBHOM) on independent data and presents further refinements to the model. Methods: Data from 306 patients who underwent lower limb amputation over a 4-year period were collated. Urea, creatinine, sodium, potassium, hemoglobin, white cell count, albumin, age, gender, mode-of-admission, and short-term mortality events were extracted from the database. This study tests an existing model and trains a new model for predicting mortality using forward stepwise logistic regression. Results: The existing model suggests a significant lack of fit (c-index = 0.665, P = .04). For the exception of gender and mode-of-admission, all predictor variables had significant univariate associations with short-term mortality ( P < .05). The refined model included age, sodium, potassium, creatinine, and albumin and had good discriminatory power (c-index = 0.8, no evidence of lack of fit, P = .616). Conclusions: Our simplified model had good predictive ability and suggests redundancy in input variables used by the existing models.
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Antonelli, Massimo, Elie Azoulay, Marc Bonten, Jean Chastre, Giuseppe Citerio, Giorgio Conti, Daniel De Backer, et al. "Year in review in Intensive Care Medicine 2010: II. Pneumonia and infections, cardiovascular and haemodynamics, organization, education, haematology, nutrition, ethics and miscellanea." Intensive Care Medicine 37, no. 2 (January 12, 2011): 196–213. http://dx.doi.org/10.1007/s00134-010-2123-y.
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Tonstad, Serena, Tor Ole Klemsdal, Sverre Landaas, and Aud Høieggen. "No effect of increased water intake on blood viscosity and cardiovascular risk factors." British Journal of Nutrition 96, no. 6 (December 2006): 993–96. http://dx.doi.org/10.1017/bjn20061969.
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Observational data have suggested that increased water intake decreases the risk of CHD. A postulated mechanism is that increased water ingestion reduces blood viscosity. The aim of the present study was to assess the effect of increased fluid intake on blood viscosity. Men (n 67) and postmenopausal women (n 27) with one or more risk factors for CVD who reported intake of ≤ 0·5 litres water daily were randomised to a control group (n 31), an intervention group (n 32) that increased their daily water intake by 1 litre/d and an intervention group (n 31) that ingested 1 litre blueberry juice/d. All were encouraged to continue their usual diet and lifestyle. Whole-blood viscosity and blood and urine chemistries were measured by standard techniques after 2 and 4 weeks. Urine volume increased (by a median of 872 and 725 ml in the water and blueberry juice groups, respectively, v. 10 ml in the control group; P ≤ 0·002), confirming the subjects' adherence to the protocol. Urine osmolality and urinary levels of Na, K and creatinine decreased in the water and blueberry juice groups v. the controls (P < 0·05). No change was seen in whole-blood viscosity or in levels of fibrinogen, total protein, lipids, glucose, insulin, C-peptide or other chemistry and haematology variables. In conclusion, a postulated protective effect of increased water or fluid intake is not explained by a change in blood viscosity and increased fluid intake does not influence CVD risk factors in the short term.
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Moore, Gary. "Recent Guidelines and Recommendations for Laboratory Detection of Lupus Anticoagulants." Seminars in Thrombosis and Hemostasis 40, no. 02 (February 5, 2014): 163–71. http://dx.doi.org/10.1055/s-0033-1364185.
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The International Society on Haemostasis and Thrombosis (ISTH) and the British Committee for Standards in Haematology (BCSH) have recently updated their lupus anticoagulant (LA) detection guidelines. The Clinical and Laboratory Standards Institute (CLSI) subsequently will publish its first LA guideline. General agreement exists on issues such as sample preparation, the use of dilute Russell viper venom time (dRVVT) in diagnostic repertoires, the use of normalized ratios, calculations to demonstrate phospholipid dependence, calculations to demonstrate inhibition, and interpretive reporting. The ISTH recommendation to employ only dRVVT and activated partial thromboplastin time is not mirrored in the BCSH and CLSI documents. The potential for false negatives in mixing tests is acknowledged by all panels, yet they remain mandated by ISTH as there are occasions when they are crucial to diagnostic accuracy. BCSH indicates that a negative mixing test need not exclude the presence of a LA, and CLSI reprioritizes test order to screen-confirm-mix, the latter being considered unnecessary in specific circumstances. Opinions in the guidelines differ on setting cutoff levels (i.e., 97.5th vs. 99th percentile for normally distributed data). All guidelines cover testing of anticoagulated patients, more detail being given by BCSH and CLSI, who suggest that Taipan snake venom time is a useful adjunct test in patients receiving vitamin K antagonists. Although complete agreement is not apparent, the guidelines represent significant moves toward engendering common practices.
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Voigtlaender, Minna, and Florian Langer. "Management of cancer-associated venous thromboembolism – a case-based practical approach." Vasa 47, no. 2 (March 1, 2018): 77–89. http://dx.doi.org/10.1024/0301-1526/a000684.
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Abstract. In patients with solid tumours or haematological malignancies, venous thromboembolism (VTE) is a leading cause of death and significantly contributes to morbidity and healthcare resource utilization. Current practice guidelines recommend long-term anticoagulation with low-molecular-weight heparin (LMWH) as the treatment of choice for cancer-associated VTE, based on clinical trial data showing an overall improved safety and efficacy profile of LMWH compared to vitamin K antagonists. However, several open questions remain, e. g. with regard to the intensity and duration of LMWH therapy; moreover, recent real-world evidence indicates that adherence to parenteral anticoagulation with LMWH over the course of treatment is poor in clinical practice. In this regard, the direct oral factor Xa or thrombin inhibitors (DOACs) have emerged as potential alternatives in the management of patients with cancer-associated VTE, albeit findings from randomized controlled studies with a direct head-to-head comparison of DOACs with LMWH, the current standard of care, are still lacking. Based on the case of a lymphoma patient experiencing symptomatic pulmonary embolism during immunochemotherapy, this article aims at both highlighting the current state-of-the-art approach to cancer-associated VTE and pointing out some of the unresolved, controversial issues clinicians have to face when taking care of haematology and oncology patients with already established or with high risk of developing VTE. These issues include the management of patients with incidental pulmonary embolism or thrombocytopenia, the use of DOACs, and the initiation of pharmacological thromboprophylaxis in non-surgical cancer patients.
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Sanders, Thomas A. B., Kelly Gleason, Bruce Griffin, and George J. Miller. "Influence of an algal triacylglycerol containing docosahexaenoic acid (22:6n-3) and docosapentaenoic acid (22:5n-6) on cardiovascular risk factors in healthy men and women." British Journal of Nutrition 95, no. 3 (March 2006): 525–31. http://dx.doi.org/10.1079/bjn20051658.
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The intake of long-chainn-3 PUFA, including DHA (22:6n-3), is associated with a reduced risk of CVD.Schizochytrium sp.are an important primary source of DHA in the marine food chain but they also provide substantial quantities of then-6 PUFA docosapentaenoic acidn-6; DPA). The effect of this oil on cardiovascular risk factors was evaluated using a double-blind randomised placebo-controlled parallel-design trial in thirty-nine men and forty women. Subjects received 4g oil/d for 4 weeks; the active treatment provided 1·5g DHA and 0·6g DPA. Active treatment increased plasma concentrations of arachidonic acid, adrenic acid, DPA and DHA by 21, 11, 11 and 88mg/l respectively and the proportions of DPA and DHA in erythrocyte phospholipids by 78 and 27% respectively. Serum total, LDL- and HDL-cholesterol increased by 0·33mmol/l (7·3%), 0·26mmol/l (10·4%) and 0·14mmol/l (9·0%) compared with placebo (allp≤0·001). Factor VII (FVII) coagulant activity increased by 12% following active treatment (P=0·006). There were no significant differences between treatments in LDL size, blood pressure, plasma glucose, serum C-reactive protein, plasma FVII antigen, FVII activated, fibrinogen, von Willebrand factor, tocopherol or carotenoid concentrations, plasminogen activator inhibitor-1, creatine kinase or troponin-I activities, haematology or liver function tests or self-reported adverse effects. Overall, the oil was well tolerated and did not adversely affect cardiovascular risk.
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Klein, Jennifer H., Andrea Beaton, Alison Tompsett, Justin Wiggs, and Craig Sable. "Effect of anaemia on the diagnosis of rheumatic heart disease using World Heart Federation criteria." Cardiology in the Young 29, no. 7 (June 20, 2019): 862–68. http://dx.doi.org/10.1017/s1047951119000404.
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AbstractBackground:There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.Objective:To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.Method/Design:A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.Results:Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).Conclusion:Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.
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Belčič Mikič, Tanja, Bor Vratanar, Tadej Pajič, Saša Anžej Doma, Nataša Debeljak, Irena Preložnik Zupan, Matjaž Sever, and Samo Zver. "Is It Possible to Predict Clonal Thrombocytosis in Triple-Negative Patients with Isolated Thrombocytosis Based Only on Clinical or Blood Findings?" Journal of Clinical Medicine 10, no. 24 (December 11, 2021): 5803. http://dx.doi.org/10.3390/jcm10245803.
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JAK2, MPL, and CALR mutations define clonal thrombocytosis in about 90% of patients with sustained isolated thrombocytosis. In the remainder of patients (triple-negative patients) diagnosing clonal thrombocytosis is especially difficult due to the different underlying conditions and possible inconclusive bone marrow biopsy results. The ability to predict patients with sustained isolated thrombocytosis with a potential clonal origin has a prognostic value and warrants further examination. The aim of our study was to define a non-invasive clinical or blood parameter that could help predict clonal thrombocytosis in triple-negative patients. We studied 237 JAK2 V617-negative patients who were diagnosed with isolated thrombocytosis and referred to the haematology service. Sixteen routine clinical and blood parameters were included in the logistic regression model which was used to predict the type of thrombocytosis (reactive/clonal). Platelet count and lactate dehydrogenase (LDH) were the only statistically significant predictors of clonal thrombocytosis. The platelet count threshold for the most accurate prediction of clonal or reactive thrombocytosis was 449 × 109/L. Other tested clinical and blood parameters were not statistically significant predictors of clonal thrombocytosis. The level of LDH was significantly higher in CALR-positive patients compared to CALR-negative patients. We did not identify any new clinical or blood parameters that could distinguish clonal from reactive thrombocytosis. When diagnosing clonal thrombocytosis triple-negative patients are most likely to be misdiagnosed. Treatment in patients with suspected triple negative clonal thrombocytosis should not be delayed if cardiovascular risk factors or pregnancy coexist, even in the absence of firm diagnostic criteria. In those cases the approach “better treat more than less” should be followed.
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Ombajo, Loice Achieng, Nyamai Mutono, Paul Sudi, Mbuvi Mutua, Mohammed Sood, Alliyy Muhammad Loo, Phoebe Juma, et al. "Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study." BMJ Open 12, no. 5 (May 2022): e049949. http://dx.doi.org/10.1136/bmjopen-2021-049949.
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ObjectivesTo assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality.SettingThis study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya.ParticipantsWe enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded.Primary and secondary outcome measuresThe primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality.ResultsData from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30–53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death.ConclusionsThe risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.
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Jamalludin, Amira Nabiha, and Nur Amalina Binti Che Din. "Necrotic Sequelae of COVID-19 Vasculitis in Geriatric Patient." International Journal of Human and Health Sciences (IJHHS) 5, no. 0-2 (September 23, 2021): 10. http://dx.doi.org/10.31344/ijhhs.v5i0-2.328.
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COVID-19 vasculitis has recently been reported in COVID-19 articles. Cutaneous manifestations can progress to necrotic skin lesion in 6% of cases. This is theoretically linked with advanced age and severe degree of infection. (1) This is a case of a 90-year-old female from a care home with a background history of dementia, heart failure, hypothyroidism, diabetes and pacemaker-in-situ. She presented with fever and tachycardia. COVID-19 test turned out positive. Electrocardiogram (ECG) showed atrial fibrillation with rapid ventricular response of spontaneous resolution. Several days later, she had recurrent supraventricular tachycardia which was resolved by adenosine. The day after, she developed multiple petechiae on hands, feet and nose. Among differentials made were infective endocarditis, heparininduced thrombocytopenia and idiopathic thrombocytopenic purpura. Full blood count revealed thrombocytopenia with p-anca positive on vasculitis screen. The lesions progressed into necrotic skin breakdown, which was unaesthetically pleasant for the patient. Final diagnosis by a Geriatrician was COVID-induced vasculitis. Multidisciplinary team (MDT) consisted of Cardiology, Haematology, Dermatology, Rheumatology and Plastic Surgery were involved in decision-making for investigations and treatment. COVID-19 vasculitis in this case possibly augmented by other factors. The pre-existing heart failure may act as cardiovascular risk factor, predisposing to systemic vascular failure thus intensifies thrombosis. (1) Besides that, can it be aggravated by hypothyroidism whereby autoimmunity is the precursor? This case holds impactful clinical significance, opening doors to future research and audit. MDT involvement is highly valued thus magnifying quality of patient care and safety. Together with comprehensive geriatric assessment where physical, functional, mental, social and environmental factors are taken into management.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S10
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Dearani, Joseph A., Heidi M. Connolly, Richard Martinez, Hector Fontanet, and Gary D. Webb. "Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond." Cardiology in the Young 17, S4 (September 2007): 87–96. http://dx.doi.org/10.1017/s1047951107001199.
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AbstractPatients with congenital cardiac disease require lifelong medical care. Current challenges that face practitioners who care for adults with congenital heart disease include identifying the best location for procedures, which could be a children’s hospital, an adult hospital, or a tertiary care facility; providing appropriate antenatal management of pregnant women with congenitally malformed hearts, and continuing this care in the peripartum period; and securing the infrastructure and expertise of the non-cardiac subspecialties, such as nephrology, hepatology, pulmonary medicine, and haematology. The objectives of this review are to outline the common problems that confront this population of patients and the medical community, to identify challenges encountered in establishing a programme for care of adults with congenitally malformed hearts, and to review the spectrum of disease and operations that have been identified in a high volume tertiary care centre for adult patients with congenital cardiac disease. Three chosen examples of the fundamental problems facing the practitioner and patient in the United States of America in 2007 are the neglected patient with congenital cardiac disease, weak infrastructure for adults with congenital cardiac disease, and family planning and management of pregnancy for patients with congenital cardiac disease.Patients with adult congenital cardiac disease often do not receive appropriate surveillance. Three fundamental reasons for this problem are, first, that most adults with congenitally malformed hearts have been lost to follow-up by specialists, and are either receiving community care or no care at all. Second, patients and their families have not been educated about their malformed hearts, what to expect, and how to protect their interests most effectively. Third, adult physicians have not been educated about the complexity of the adult with a congenitally malformed heart. This combination can be fatal for adults with complications related to their congenitally malformed heart, or its prior treatment. Two solutions would improve surveillance and care for the next generation of patients coming out of the care of paediatric cardiologists. The first would be to educate patients and their families during childhood and adolescence. They would learn the names of the diagnoses and treatments, the problems they need to anticipate and avoid, the importance of expert surveillance, career and family planning information, and appropriate self-management. The second solution would be to encourage an orderly transfer of patients from paediatric to adult practice, usually at about 18 years of age, and at the time of graduation from high school.Clinics for adults with congenital cardiac disease depend upon multidisciplinary collaboration with specialties in areas such as congenital cardiac imaging, diagnostic and interventional catheterization, congenital cardiac surgery and anaesthesia, heart failure, transplantation, electrophysiology, reproductive and high risk pregnancy services, genetics, pulmonary hypertension, hepatology, nephrology, haematology, and others. None of these services are easily available “off the rack”, although with time, experience, and determination, these services can develop very well. Facilities with experienced personnel to provide competent care for adults with congenital cardiac disease are becoming increasingly available. Parents and patients should learn that these facilities exist, and be directed to one by their paediatric caregivers when the time comes for transition to adult care.With the steady increase in the number of adults with congenital heart disease, an ever increasing number of women with such disease are becoming pregnant. Services are not widely available to assess competently and plan a pregnancy for those with more complex disease. It is essential to have a close interplay between the obstetrician, the adult congenital cardiologist, the fetal medicine perinatologist, and neonatologist.In both a community based programme and a tertiary care centre, the nuances and complexities of congenital cardiac anatomy, coupled with the high probability of previous operation during childhood, makes the trained congenital cardiothoracic surgeon best suited to deal with the surgical needs of this growing population. It is clear that the majority of adults with congenital heart disease are not “cured”, but require lifelong comprehensive care from specialists who have expertise in this complex arena. There is a growing cadre of healthcare professionals dedicated to improving the care of these patients. More information has become available about their care, and will be improved upon in the next decade. With the support of the general paediatric and paediatric cardiologic communities, and of the Adult Congenital Heart Association, and with the persistence of the providers of care for adults with congenital cardiac disease currently staffing clinics, the care of these patients should become more secure in the next decade as we mature our capabilities.
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Borzykh, O. A., A. V. Lavrenko, L. G. Selikhova, N. I. Digtyar, N. D. Gerasimenko, Y. M. Avramenko, O. V. Belan, G. O. Кolomiets, I. A. Mormol, and I. P. Kaidashev. "MODERN ASPECTS OF FREE RADICAL PATHOLOGY (LITERATURE REVIEW AND OWN RESEARCH)." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 20, no. 1 (April 9, 2020): 4–8. http://dx.doi.org/10.31718/2077-1096.20.1.4.
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Today, there have been numerous studies that show the emergence and development of various pathologies accompanied by the activation of free radical reactions. It should be noted that the current clinical experience and results of experimental studies indicate the important role of oxidative stress in the formation and progression of cardiovascular pathology, and a series of reports are devoted to the study and comparison of the distinctive features of free radical lipid oxidation and proteins in patients with endothelial dysfunction and various functional classes of angina. Despite the considerable period that has elapsed since the Chernobyl disaster, the medical and biological problems of long-term effects of ionizing radiation are remaining relevant. However, it should be noted that according to some authors, the ideas of lipid peroxidation, mainly based on in vitro studies, do not meet the requirements for recognizing the existence of a metabolic process or metabolic pathway. In recent years, the Department of Internal Medicine # 3 with Phthisiology has conducted the number of multidirectional studies focused on various aspects of free radical pathology in experimental and clinical medicine on cardiology, nephrology, immunology, haematology, pulmonology, and gastroenterology. According to the results of the literature review and comprehensive analysis of the conducted research, we can point out that the study of the role of free radical processes in experimental and clinical medicine is still remaining quite relevant. The scientific search and practical value of these studies can lead to new insight in the context of an overall deterioration of the environment and exposure to negative environmental factors.
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Ahmad, Rahnuma, Qazi Shamima Akhter, Mahmuda Abira, Farhana Rahman, Suparna Bhowmik, Farhana Hussain Sadia, and Tahmina Akter. "Effects of Exposure of Cement Dust on Platelet Count in Workers of a Cement Mill." Medicine Today 34, no. 1 (April 24, 2022): 44–46. http://dx.doi.org/10.3329/medtoday.v34i1.58674.
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Introduction: Cement dust is emitted during the different steps of cement production. This dust is composed of chemical components that may have unfavourable effects on the haematological system. The workers in these factories are exposed daily to this toxic dust. Those exposed to the cement dust may suffer from changes in platelet count and eventually suffer from damaging effects on the cardiovascular system. Objective: Assess the effects of cement dust on platelet count of cement mill workers. Materials and Methods: Conduction of this cross sectional study took place in the Department of Physiology, Dhaka Medical College, Dhaka between July 2017 to June 2018. After fulfilling the ethical consideration, 46 apparently healthy male cement mill workers, working for 2 or more years in a cement mill , with range of age of 20 to 50 years (study group) and 46 BMI, age and socioeconomic condition matched apparently healthy male subjects from Dhaka city were control group. The platelet count was estimated using automated haematology analyzer in Dhaka Medical College Hospital, Dhaka. Data was collected in a pre-designed structured questionnaire form. Unpaired Student’s ‘t’ test and Pearson’s correlation coefficient test were performed for statistical analysis. Results: In this study, the platelet count was significantly (p < 0.05) higher than those of control group. The platelet count was directly related with duration of cement dust exposure. Conclusions: This study concludes that the cement dust has harmful effect on the platelet count and the duration of exposure to cement dust also has an effect on this parameter. Medicine Today 2022 Vol.34(1): 44-46
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Oladele, G. M. "Effects of aqueous extract of Nelsonia canescens leaf on the osmotic fragility of red blood cell and blood parameters of Wistar albino rats." Journal of Veterinary and Biomedical Sciences 1, no. 1 (June 1, 2018): 1–10. http://dx.doi.org/10.36108/jvbs/8102.10.0110.
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The herbaceous plant Nelsonia canescens is a medicinal plant used in Asian and African traditional medicine for various diseases of humans and animals. The plant has been used for the treatment of pains and inflammatory action related diseases, cancer, gout, cough, fever, cardiovascular diseases, chicken pox and even malaria. Decoction of it has also been used as immune booster in patients by the traditionalists. This study was aimed at evaluating the effects of the aqueous leaf extract of the plant on the osmotic fragility of rats’ red blood cells, and also to determine the changes that occur in haematology and serum chemistry of the rats exposed orally to the extract for 28 days. Three groups of rats were administered orally with 200, 400, and 800mg/kg of the plant extract respectively while the fourth group which is the control was administered also orally with distilled water and their blood were then analyzed. The 2, 4 and 6mg/ml concentrations of the extract inhibit hypotonic solution induced rats erythrocytes hemolysis in concentration dependent manner and the inhibition is comparable to that of Indomethacin. The blood analysis showed a significant increase (p<0.05) in total white blood cells and the lymphocytes for the groups administered with 400 and 800 mg/kg of the extract while the neutrophils decreased significantly. It was then concluded that the aqueous extract of the plant inhibits red blood cell hemolysis and hence its anti-inflammatory activities. Also, the significant increase in the total white blood cells and the lymphocytes could be the reason why the plant is useful as immune booster by the traditionalists.
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Lim, Chi Ching, Xiaojuan Chen, Yee Mei Lee, Winnie ZY Teo, Moon Ley Tung, Wee-Joo Chng, and Melissa Ooi. "Feasibility of Advanced Practice Nurse - Led Telehealth Service in Patients with Myeloproliferative Neoplasm in the Community: A Singapore Single-Centre Report." Blood 136, Supplement 1 (November 5, 2020): 18–19. http://dx.doi.org/10.1182/blood-2020-138410.
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Introduction Telehealth is fast becoming a promising alternative service for face-to-face consultation in healthcare to improve access to healthcare in a cost effective manner. An academic medical centre (AMC) piloted a tele-consultation program for patients with myeloproliferative neoplasm (MPN), a disease with an abnormal mutation in the bone marrow leading to overproduction of any combination of white cells, red cells and platelets. The program aimed to demonstrate the feasibility and safety of the use of telehealth in managing patients with MPN. Methods For this program only patients with Essential Thrombocytosis (ET) and Polycythemia Vera (PV) who met the criteria were recruited and enrolled into the program. Workflows, logistics and education materials were developed and briefed to stakeholders prior to the commencement of the program. The program utilised the Advanced Practice Nurses' (APNs) expertise in the haematology unit to support the service. APNs were provided addition training on both clinical practice knowledge and the appropriate use of the telehealth equipment. Data was collected between January and July 2020. Prospective outcome indicators measured were i) correct treatment prescribed according to guidelines; ii) number of emergency visits due to events related to MPN and its complications, iii) deterioration in cardiovascular health (namely hypertension, diabetes mellitus and hyperlipidermia) iv) number of patient visits right-sited to the community and v) barriers and facilitators for the uptake of the program. Results A total of 21 patients with 44 tele-consults over 7 months was captured. Average age of the patients were 70.1 years. Thirteen patients were diagnosed with ET and 8 patients have PV. Only 1 patient was on a combination of hydroxyurea and anagrelide, the rest of the patients were on hydroxyurea. A total of 14 dosage adjustments were made based on patients' complete blood count, and all of patients' blood countsremained stable during the following review. Two venesections were prescribed for patients with PV. None of the patients required ED visit or admission due to events related to MPN and its complications. One patient was referred back to physician earlier due to non-compliance to telehealth review. All patients had their blood pressure reviewed within 1 year. Sixteen patients had fasting glucose/HbA1c within 2 years, and 14 patients had fasting lipid within 2 years. None of the patients required cardiovascular medication titration, thus there is no deterioration in their cardiovascular health since recruitment. For 9 of the telehealth review, patients did their blood tests concurrently with other medical appointments they had at an earlier date, hence saving a separate trip to hospital for blood test. We were also able to consolidate blood tests and reduce repetition for these 9 patients. Only 8 telehealth blood tests were done in the community, largely due to the closure of satellite blood test service during COVID pandemic. There were only 6 home medicine deliveries, largely because many of the patients had collected adequate medications lasting half a year to a year during physical consult with physicians. The MPN telehealth service has right sited a total of 67 hospital visits to the community. We determined the barriers and facilitators to the program are due to patient, physician and workflow factors. Some of our older patients do not own a mobile device, or prefer traditional, physical consultations with physicians. Some physicians are unfamiliar with telehealth referral workflow. Potential facilitators include older, immobile patients with multiple comorbiditieswanting to cut down hospital visits, as well as patients whose work schedule did not permit frequent hospital visits. Conclusions Our results show that utilising APN-led telehealth service is a feasible and safe method to deliver care to patients with myeloproliferative neoplasm in the community. Right-siting of patient care could reduce patient visits to hospitals especially during COVID pandemic. Ongoing challenges include increasing the number of blood test facilities in the community to facilitate blood taking in the community. Other proposed intangible benefits would include improving patients' psychosocial well-being by transiting them to a new normalcy with minimal hospital visits to a haematology centre. There is potential cost- saving as well that will be explored. Disclosures Chng: Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria; Abbvie: Honoraria; Amgen: Honoraria, Research Funding.
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Khunger, Jitender, Monica Malhotra, Nitin Kumar, VPS Punia, and Mohan Agarwal. "To Study the Coagulation Profile Derangements in Metabolic Syndrome." Blood 134, Supplement_1 (November 13, 2019): 4959. http://dx.doi.org/10.1182/blood-2019-125048.
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Introduction: The metabolic syndrome is a complex disorder characterized by the presence of a clustering of metabolic risk factors usually in a single individual associated with the presence of central obesity and a strong association with diabetes and cardiovascular disease morbidity and mortality. It is a fast spreading global pandemic & emerging as a public health problem with poor outcome and Quality of life thus more predilection is towards preventive than curative treatment. According to WHO Clinical Criteria, Metabolic syndrome is defined as insulin resistance, identified by 1 of the following, Type 2 diabetes, fasting blood glucose more than 110 mg/dl plus any 2 of the following: antihypertensive medication and /or high blood pressure > 140 mm systolic or >90 mm diastolic, plasma triglyceride (TG) level more than 150 mg/dl (1.7 mmol/L), high-density lipoprotein (HDL) cholesterol level less than 35 mg/dl (0.9 mmol/L) in men or less than 39 (1.0 mmol/L)in women , BMI >30 kg/m2 and/or waist:hip ratio >0.9 in men, > 0.85 in women, Urinary albumen excretion rate > 20 mcg/min or albumin:creatinine ratio>30mg/g Aims & Objectives: To investigate the coagulation profile derangements in metabolic syndrome. To study the relationship of various components of metabolic syndrome with coagulation parameters. Material & Methods: This was a prospective cross-sectional study carried out in Haematology & Medicine Deptt of SafdarJang Hospital, New Delhi. After taking consent from the Hospital Ethics Committee, a total of 50 cases of metabolic syndrome presenting as outpatient or inpatient were included in the study. 50 age & sex matched controls were selected which did not satisfy the criteria for metabolic syndrome. Observation & Results: In our study we found that the cases with metabolic syndrome have significantly increased levels of Fibrinogen, Factor VIII and Plasminogen Activator Inhibitor1 (PAI1). PT & APTT were shorter in cases with metabolic syndrome. The mean value of fibrinogen in cases was 402.24 ± 66.92 mg/dl while that in control was 261.5 ± 41.95 mg/dl with a P value of <.0001 which was statistically significant. The mean value of Factor VIII in cases was 152.66 ± 7.54 IU/dl while that in control was 131.44 ± 6.24 IU/dl with a P value of <.0001 which was statistically significant. The mean value of Plasminogen Activator Inhibitor1 (PAI1) in cases was 49.99 ± 5.34 ng/ml while that in control was 36.75 ± 3.35 ng/ml with a P value of <.0001 which was statistically significant. Prothrombin Time (PT) values in cases were 9.79 ± 0.74 seconds and in controls were 12.04 ± 0.7 seconds & this difference was statistically significant (p<.0001). Activated partial Thromboplastin Time (APTT) values in cases were 28.96 ± 0.92 seconds and in controls were 32.6 ± 1.34 seconds & this difference was statistically significant (p<.0001). Conclusions: The coagulation parameters studied correlated significantly with the components of metabolic syndrome. The values varied significantly with increased number of features of metabolic syndrome. Thus we can conclude that metabolic syndrome is a hypercoagulable state and further studies are required for further evaluation of the consequences of this hypercoagulable state.. Disclosures No relevant conflicts of interest to declare.
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Isang, Emmanuel Emmanuel, Jonathan Dewald, Mark Rasnake, and Robert E. Heidel. "Evaluation of Inpatient Thrombophilia Pathway." Blood 128, no. 22 (December 2, 2016): 4741. http://dx.doi.org/10.1182/blood.v128.22.4741.4741.
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Abstract Introduction: Venous thromboembolism (VTE) ranges from asymptomatic deep vein thrombosis (DVT) to fatal pulmonary emboli (PE). VTE is the third most common cardiovascular illness and cause of mortality after acute coronary syndrome and stroke. Medical societies such as American Society of Hematology (ASH), British Society for Haematology, and Society for Vascular Medicine have all created selection criteria, consistent with each other, for when to order a hereditary thrombophilia workup. Guidelines indicate that thrombophilia testing should not be offered to patients who are continuing anticoagulation treatment, or to those who have had "provoked" VTE. Examples include patients who have had a transient risk factor within the past 3 months including surgery, trauma, prolonged immobility, pregnancy or puerperium, and patients on hormonal therapy. The aims of our study is to identify the prevalence of hypercoagulable testing in our hospital, evaluate how our organization follows certain criteria for patients presenting with DVT or PE, and to calculate the economic impact of ordering these workups unnecessarily. Methods We conducted a retrospective chart review from July 2014 to June 2015 that identified individuals that were admitted to the hospital with a diagnosed DVT or PE detected by lower extremity doppler ultrasound or computed tomography of the lungs. Inclusion criteria included newly diagnosed patients with DVT or PE. Frequencies were calculated for sex, work-up, ethnicity, smoking, estrogen therapy, malignancy, and history of VTE. Further analysis was run using work-up as predictor variable and cross tabulated with sex, ethnicity, smoking, estrogen therapy, malignancy and history of VTE. Independent t-test were conducted between work-up and age and BMI levels. Results We identified 241 patients admitted to the hospital for DVT or PE. Within this population, 57 individuals (23.7%) had the hypercoagulability pathway. A majority of the patients within this subpopulation were female (57.9%). Sensitivity analysis for the 57 individuals who underwent work-up also included 38.6% with a smoking history, 3.5% on estrogen therapy, 86% without history of malignancy, 40.4% with history of previous DVT or PE, and 89.5% of the patients being Caucasian. The average age and BMI was 55 and 32.9 respectively. No significant relationship was found between the work-up and sex (p= 0.11), ethnicity (p=.65), smoking (p=0.46), estrogen therapy (p= 0.8), without malignancy (p=.051), and history of DVT or PE (p=0.12). There was a significant relationship between age and work-up (p=0.002), with younger patients more likely to have the work-up. Conclusion Our study indicated that younger patients presenting with VTE were likely to under go work-up for thrombophilic disorders. Patients without malignancy and those who did not smoke were also more likely to undergo a work-up. In addition to this, women not on estrogen therapy were less likely to receive a work-up. Even though our results allude to inappropriate thrombophilia testing, we lack statistical significance due to our population size and patient diversity. These tests are expensive, with costs approaching $3,000 for a full thrombophilia panel. This totals around $100,000 to $160,000 of cost savings for the 53 individuals that had the work-up within the one year span. This cost analysis does not include the expense accrued by the patient for prolonged anticoagulation plus the ongoing lab costs of INR monitoring. Research should be further investigated in a larger and more diverse population for better understanding for the role of thrombophilia evaluation in the inpatient setting. Disclosures No relevant conflicts of interest to declare.
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Viligorska, K. "Haematology department nurses training makes a positive shift in reduction of in-hospital cardiac mortality." European Journal of Cardiovascular Nursing 20, Supplement_1 (July 1, 2021). http://dx.doi.org/10.1093/eurjcn/zvab060.087.
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Abstract Funding Acknowledgements Type of funding sources: None. Introduction Due to general profile of emergency hospital it is lacking of regular specific training courses for nurses. Haematology department is the one that has a great number of complications after immunosuppressive and chemo-therapy that is why skills in acute cardiovascular care are crucial for haematology healthcare professionals. Training of basic skills of management of acute cardiac events for nurses that work with haematological patients should be considered as routine practice in order to improve patients’ care. Purpose Science is not a study, but an observation of what is around us, therefore we made a registry of acute cardiovascular events over the hospital departments and defined a need for acute cardiovascular training for nurses in haematology department. Methods Data analysis of 1 year observational study of acute cardiac events at emergency hospital was done. Nurses of haematology department were specifically instructed to provide first aid and contact internal medicine doctor on duty in case of signs of cardiovascular events in patients with acute lymphoblastic leukemia that were under 21-st day of chemotherapy due to high risk of thromboembolic complications. Among 573 cases, 110 cases were cardiovascular events diagnosed and managed at haematology department by emergency care multidisciplinary team of internal medicine doctor on duty and haematology nurses. For statistical analysis Microsoft Excel v.2019 was used. Results At haematology department of emergency hospital we detected 110 cases of cardiovascular events. Among them 50 cases of ST-elevation myocardial infarction (STEMI) treated in the first 10 minutes of the episode with successful outcome, 45 cases of ischemic stroke, only 5 of which were lethal due to severity of neurologic disorders, 15 cases of pulmonary embolism with successful outcome. Conclusion Training on acute cardiovascular care for haematology department nurses was beneficial and contributed to lower hospital mortality.
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"Perfusion Workshop 2000 Perfusion Haematology." Perfusion 16, no. 5 (September 2001): 337–38. http://dx.doi.org/10.1177/026765910101600502.
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Bisceglia, I., R. Mistrulli, D. Cartoni, V. Buffa, R. Battistini, A. Proia, L. Rigacci, and S. Petrolati. "C50 CARDIO–ONCO–HAEMATOLOGY IN CLINICAL PRACTICE. A “CHANGELING” CASE: MORE THAN PARADOXICAL BUBBLES." European Heart Journal Supplements 24, Supplement_C (May 1, 2022). http://dx.doi.org/10.1093/eurheartj/suac011.049.
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Abstract 39–year–old female, without cardiovascular risk factors. At the end of pregnancy she complained of progressive dyspnoea and so she was admitted to the emergency room. Blood tests showed elevated D–dimer and LDH values. A chest CT scan was performed showing a mediastinal mass of about 15 cm encompassing the ascending aorta, the left brachiocephalic trunk and the superior vena cava, both of which appeared thrombosed. Therapy with low molecular weight heparin was started. The patient underwent a mediastinal biopsy, which documented a primary mediastinal non–Hodgkin‘s lymphoma. The baseline cardiological evaluation showed a preserved ejection fraction (60%) at echocardiogram (ECHO). The first cycle of chemotherapy with R–CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine) was started. After an episode of hypoesthesia of the left upper limb, that regressed spontaneously within a few hours, she performed MRI that showed multiple areolas compatible with ischemic disease. Following these results the patient was submitted to an ECHO with saline solution injected through the right brachial vein that documented evidence of early opacification of the left atrium and subsequent opacification of the right sections (after 3 cardiac cycles) (Fig. 1–2). This finding suggested a right–to–left shunting, via the bronchial lower district to the left atrium (pulmonary veins). This suspicion was confirmed by CT angiography, which showed occlusion of the superior vena cava with passage of contrast into azygos and early opacification of peribronchial venous circles (Fig. 3). A patency of foramen ovale was ruled out by injection of saline solution through the femoral vein. After the second cycle of chemotherapy, ECHO showed diffuse hypokinesia and reduced EF to 50%. It was then decided to proceed with the third cycle according to the intensified R–DAEPOCH scheme, except for doxorubicin, because of the cardiotoxicity developed by the patient. A cardioprotective therapy was also started with bisoprolol and ramipril with rapid titration. At subsequent radiological controls, a progressive reduction of the mediastinal mass was found and after just one month, the echocardiogram showed a complete recovery of the EF. Contrast injection confirmed presence of a veno–venous shunt. Cardio–oncology is an intriguing and complex discipline that requires the development of local multidisciplinary teams for challenging situations that patients with cancer may ask us to address.
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Lee, Richard E. "Abstract 3201: Impact of a Stroke "Quick Look" Assessment on meeting Brain Attack Coalition Guidelines." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a3201.
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Background and Issues: Emergency Departments (ED) are challenged to meet Brain Attack Coalition Guidelines (BACG) for treatment of patients with acute stroke symptoms. BACG recommends that patients with acute stroke symptoms be assessed by a physician within 10 minutes of arrival to the ED, have a Computed Tomography (CT) scan within 25 minutes, receive results of the CT scan within 45 minutes, and receive intravenous TPA within 6o minutes if appropriate. Purpose: The purpose of our study was to radically change our delivery system for stroke patients and exceed BACG guidelines to improve patient outcomes for an emergency department servicing greater than 100,000 visits annually. Methods: The innovation that was vital in streamlining our process was a “Quick Look” neuro assessment by a physician for patients presenting with acute stroke symptoms. At-risk patients progress immediately to radiology, bypassing the traditional serial process of going straight to an ED room and waiting for the stroke team. Implementation of this “Quick Look” process included activation of the Neurologist and Rapid Response Team member. Results: A retrospective review of 479 charts between December 2009 and December 2010 was conducted to determine process outcomes. Implementation of a “Quick Look” assessment decreased “Door to Doctor” time from 10 minutes to 2.75 minutes (73% decrease); “Door to CT” time from 41 minutes to 18 minutes (56% decrease); door-to-administration-of-IV-TPA time from 82 minutes to 62 minutes (24% decrease); “Door to CT Results” time from 53 minutes to 27 minutes (49% decrease); and “Door to IV-TPA” time from 82 minutes to 62 minutes (24% decrease). Current 2011 year to date results through June 2011 meet the BACG door-to-needle time of less than 60 minutes. Conclusions: The implementation of the “Quick Look” process has sustained these positive outcomes throughout 2011, meeting BACG the first two quarters of 2011, and meeting the American Heart Association/American Stroke Association’s Target: Stroke Honor Roll. Although the success of this process improvement was driven by the stroke council; the amazing results are due to the efforts and collaboration of a highly functioning interdisciplinary Emergency, Rapid Response and Neurosciences team.
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Fontes Oliveira, Marta, Willeke R. Naaktgeboren, Alina Hua, Arjun K. Ghosh, Heather Oakervee, Simon Hallam, and Charlotte Manisty. "Optimising cardiovascular care of patients with multiple myeloma." Heart, April 5, 2021, heartjnl—2020–318748. http://dx.doi.org/10.1136/heartjnl-2020-318748.
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Multiple myeloma (MM) is the third most common haematological malignancy, with increasing prevalence over recent years. Advances in therapy have improved survival, changing the clinical course of MM into a chronic condition and meaning that management of comorbidities is fundamental to improve clinical outcomes. Cardiovascular (CV) events affect up to 7.5% of individuals with MM, due to a combination of patient, disease and treatment-related factors and adversely impact survival. MM typically affects older people, many with pre-existing CV risk factors or established CV disease, and the disease itself can cause renal impairment, anaemia and hyperviscosity, which exacerabate these further. Up to 15% of patients with MM develop systemic amyloidosis, with prognosis determined by the extent of cardiac involvement. Management of MM generally involves administration of multiple treatment lines over several years as disease progresses, with many drug classes associated with adverse CV effects including high rates of venous and arterial thrombosis alongside heart failure. Recommendations for holistic management of patients with MM now include routine baseline risk stratification including ECG and echocardiography and administration of thromboprophylaxis drugs for patients treated with immunomodulatory drugs. Close surveillance of high-risk patients with collaboration between haematology and cardiology is required, with prompt investigation in the event of CV symptoms, in order to identify and treat complications early. Decisions regarding discontinuation of cardiotoxic therapies should be made in a multidisciplinary setting, taking into account the severity of the complication, prognosis, expected benefits and the availability of effective alternatives.
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Alagna, G., D. Di Lisi, M. Santoro, V. Accurso, C. Madaudo, D. Calcullo, S. M. Siragusa, A. R. Galassi, and G. Novo. "Usefulness of a new risk score in identifying patients with CML at increased risk of cardiovascular toxicities." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2868.
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Abstract Background Anti-BCR-ABL tyrosine kinase inhibitors (TKIs) dramatically improved the prognosis of patients with Chronic Myeloid Leukemia (CML) however they have been associated with cardiovascular (CV) complications. Purpose The primary aim of our study was to compare the usefulness of two different tools to stratify the risk of developing cardiovascular adverse events in haematology patients treated with ponatinib or nilotinib. Methods A real-life retrospective observational study was carried out on 58 patients (32 M, 26 W; mean age ± SD: 59±15) affected by CML treated with TKIs for a median period of 43±31 months. Patients were divided in groups according to CV risk estimated with SCORE and the 2020 CV risk assessment proposed by the Cardio-Oncology Study Group of the ESC/ICOS. Cardiac evaluation and echocardiogram were performed in all patients. The recorded CV adverse events were: myocardial ischemia, peripheral vascular diseases, new-onset or progression of preexisting carotid atherosclerosis, arterial hypertension, arrhythmias. Results According to SCORE, 46% of patients were at high-very high risk (group A1) and 54% at low-moderate risk (group B1). Applying the ESC/ICOS risk stratification tools, 60% were at high-very high risk (group A2) and 40% at low-medium risk (group B2). 21 CV adverse events were observed. CV adverse events were significantly more frequent in group A1 than group B1 (p value = 0,0003) when considered overall, they were significantly more frequent in group A2 than group B2 either overall (p=0,0004) or considered individually (myocardial ischemia: p=0,01; peripheral arterial disease: p=0,03). See Table 1. Moreover, the ESC/ICOS risk stratification tools was significantly more sensitive than SCORE (p=0,0004) in identifying patients at higher risk of cardiovascular toxicity. See Table 2. No patients treated with Ponatinib showed CV adverse events during follow up. It is worth of notice that all patients before starting treatment underwent cardio-oncological evaluation, risk factors correction and preventive treatment with aspirin. They also were treated with the lowest dose of TKI. None of the patients treated with nilotinib over 4 years and with multiple lines of therapy, experiencing adverse events, received aspirin in primary prevention. Conclusions Our study shows that the ESC/ICOS risk stratification tools is very sensitive and more performing than SCORE for risk stratification of cardiotoxicity in haematology patients treated with TKIs. It also suggests that baseline CV risk assessment, CV risk factors correction and preventive treatment with aspirin aid in reducing CV adverse events in patients treated with ponatinib. Funding Acknowledgement Type of funding sources: None. Table 1Table 2
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Barzkar, Farzaneh, Phyo K. Myint, Chun Shing Kwok, Anthony Kneale Metcalf, John F. Potter, and Hamid Reza Baradaran. "Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke." BMC Cardiovascular Disorders 22, no. 1 (April 9, 2022). http://dx.doi.org/10.1186/s12872-022-02600-1.
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Abstract Purpose We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting. Materials and Methods We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis. Results Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35–0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12–0.80)], without history of smoking [OR 0.34 (0.15–0.80)], and without hypertension [OR = 0.42 (95% CI 0.19–0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68–0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32–0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04–0.73)] without a history of hypertension [OR = 0.34 (0.13–0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14–0.86)]. Conclusion Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.
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Jo, Yusuke, Toshihisa Anzai, Yasuo Sugano, Hidehiro Kaneko, Kotaro Naito, Koji Ueno, Takashi Kohno, Toshiyuki Takahashi, Tsutomu Yoshikawa, and Satoshi Ogawa. "Abstract 3307: Early Use of Beta-blockers Attenuates Systemic Inflammatory Response and Lung Oxygenation Impairment after Distal Type Acute Aortic Dissection." Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_745.
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BACKGROUND: Systemic activation of the inflammatory system after aortic injury may play a role in the development of lung oxygenation impairment (LOI) in patients with acute aortic dissection (AAD). We have reported that serum C-reactive protein (CRP) elevation is an independent predictor of this complication. We evaluated the effect of beta-blocker on systemic inflammation and the development of LOI after distal type AAD. METHODS: A total of 49 patients, who were admitted with distal type AAD and treated conservatively, were examined. Patients were divided into 2 groups according to the presence or absence of beta-blocker treatment, started within 24 hours of the onset. White blood cell (WBC) count, serum CRP level and arterial blood gases were measured serially. Clinical outcome, maximum WBC count, maximum CRP level, and lowest PaO 2 /FiO 2 (P/F) ratio were compared between the two groups. RESULTS: There was no difference between the groups in patients’ backgrounds, blood pressure, serum level of CRP, WBC count and P/F ratio on admission. Beta-blocker treatment was associated with lower maximum WBC count (14,856 ± 3201 vs. 11,687 ± 2610 /mm 3 , p =0.0028) and lower maximum serum CRP level (28.2 ± 20.5 vs. 14.2 ± 5.6 mg/dl, p =0.0004). The minimum P/F ratio was higher in patients with beta-blocker than in those without (140 ± 41 vs. 226 ± 90 mmHg, p =0.0076). Multivariate analysis revealed that administration of a beta-blocker was an independent negative determinant of LOI (P/F ratio ≤ 200 mmHg). CONCLUSIONS: Early use of beta-blockers prevented excessive inflammation and LOI after distal type AAD, suggesting a pleiotropic effect of beta-blockers on the inflammatory response after AAD.
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Deshmukh, Tejas, Peter Emerson, Paul Geenty, Shehane Mahendran, Luke Stefani, Megan Hogg, Paula Brown, et al. "The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients." Heart, July 22, 2021, heartjnl—2021–319359. http://dx.doi.org/10.1136/heartjnl-2021-319359.
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ObjectiveTo evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.MethodsCross-sectional study of 120 consecutive patients post-BMT (80 pretreated with anthracyclines (BMT+AC), 40 BMT alone) recruited from a late effects haematology clinic, compared with 80 healthy controls, as part of a long-term cardiotoxicity surveillance study (mean duration from BMT to transthoracic echocardiogram 6±6 years). Left ventricular global longitudinal strain (LV GLS), global circumferential strain (LV GCS) and right ventricular free wall strain (RV FWS) were compared with traditionl parameters of function including LV ejection fraction (LVEF) and RV fractional area change.ResultsLV GLS (−17.7±3.0% vs −20.2±1.9%), LV GCS (−14.7±3.5% vs −20.4±2.1%) and RV FWS (−22.6±4.7% vs −28.0±3.8%) were all significantly (p=0.001) reduced in BMT+AC versus controls, while only LV GCS (−15.9±3.5% vs −20.4±2.1%) and RV FWS (−23.9±3.5% vs −28.0±3.8%) were significantly (p=0.001) reduced in BMT group versus controls. Even in patients with LVEF >53%, ~75% of patients in both BMT groups demonstrated a reduction in GCS.ConclusionMultiplanar strain identifies a greater number of BMT patients with subclinical LV dysfunction rather than by GLS alone, and should be evaluated as part of post-BMT patient surveillence. Reduction in GCS is possibly due to effects of preconditioning, and is not fully explained by AC exposure.
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Somarakis, K., and H. Ahmed. "P1707 Strain imaging - resolving the diagnostic conundrum of cardiac amyloidosis." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.1070.
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Abstract Introduction Cardiac amyloidosis is a common cardiac condition and is still significantly underdiagnosed. Autopsy studies revealed that myocardial tranthyretin amyloid deposition is found in up to 30% of patients with HFpEF (heart failure with preserved ejection fraction). A study in 2015 reported that 13% of patients hospitalised due to HFpEF (older than 60 years old and with left ventricular hypertrophy - LVH) had moderate to severe uptake on the Technetium DPD scintigraphy. Strain imaging through Echocardiography can be a useful diagnostic tool and can provide valuable clues towards the aetiology of LVH. Relative "apical sparing" pattern of longitudinal strain has been reported to have good sensitivity and specificity in differentiating patients with cardiac amyloidosis from controls. Case A 66 year old man presented with progressive breathlessness and peripheral oedema. His past medical history included peripheral neuropathy, bilateral decompression procedures for carpal tunnel syndrome and IgM Monoclonal Gammopathy of Undetermined Significance (MGUS). His B-type natriuretic peptide levels were elevated and his ECG showed normal sinus rhythm, RsR" pattern on the anterior leads and no evidence of LVH. The transthoracic echocardiogram showed moderate concentric LVH, normal left ventricular systolic function and mildly impaired left ventricular diastolic function. No evidence of pericardial effusion. Urine protein:creatinine ratio findings were consistent with nephrotic range proteinuria. He had a cardiac MRI that confirmed normal biventricular wall motion and systolic function and a moderate increase in the wall thickness of both ventricles, but showed no evidence of late gadolinium enhancement. At this point, we repeated his transthoracic echocardiogram with the use of strain imaging and it revealed a pattern of apical sparing suggestive of cardiac amyloidosis. After collaboration with the Haematology team, a bone marrow biopsy was performed that showed that the MGUS had progressed to IgM multiple myeloma. There was however no evidence of amyloid deposits. He was subsequently referred to the national amyloidosis centre (as per family request), where a SAP (serum amyloid P) scan showed renal and splenic amyloid deposits confirming Light-chain Amyloidosis. To exclude the possibility of TTR Amyloidosis, he also had a 99mTc-DPD scintigraphy which did not detect any amyloid deposits. He was treated under the care of the Haematology team with Velcade/Cyclophosphamide/Dexamethasone chemotherapy. Conclusion In patients with a clinical suspicion of cardiac amyloidosis, Echocardiography with strain imaging can be very useful and should be performed routinely. Furthermore, in patients with high clinical suspicion of cardiac amyloidosis, diagnostic investigations should persist even if the initial workup does not yield specific findings. Abstract P1707 Figure. Strain imaging findings
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Ware, Adam L., Lauren Reiter, Melissa Winder, Dallin Kelly, Jennifer Marietta, Sonja Ohsiek, Zhining Ou, Angela Presson, and David K. Bailly. "The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study." Cardiology in the Young, November 28, 2022, 1–8. http://dx.doi.org/10.1017/s1047951122003596.
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Abstract Objective: Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. Methods: Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes “cardiovascular” and “feeding/fluid.” Measurements and Results: Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need “cardiovascular” decreased as length of stay increased. Multivariate analysis showed Final Hospital Need “cardiovascular” was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need “respiratory” and “other.” Final Hospital Need "feeding/fluid” was negatively associated with left-sided valve procedure, but positively associated with final ICU need “respiratory,” and tube feeding at discharge. Conclusions: Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.
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Pastori, Daniele, Danilo Menichelli, Vittoria Cammisotto, and Pasquale Pignatelli. "Use of Direct Oral Anticoagulants in Patients With Antiphospholipid Syndrome: A Systematic Review and Comparison of the International Guidelines." Frontiers in Cardiovascular Medicine 8 (August 3, 2021). http://dx.doi.org/10.3389/fcvm.2021.715878.
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Antiphospholipid antibody syndrome (APS) requires long-term anticoagulation to prevent recurrent thrombosis. Direct oral anticoagulants (DOACs) have been increasingly used in APS patients, but contradictory guidelines recommendations on their use do exist. We performed a systematic review of literature including studies investigating the role of DOACs in APS patients. At this aim, PubMed and Cochrane databases were searched according to PRISMA guidelines. We identified 14 studies which investigated the use of DOACs in patients with APS, of which 3 randomized clinical trials (RCTs), 1 post-hoc analysis of 3 RCTs, 7 case series and 3 cohort studies (2 prospective and 1 retrospective). Among DOACs, rivaroxaban was the most used (n = 531), followed by dabigatran (n = 90) and apixaban (n = 46). Regarding guidelines indications, the 2019 European Society of Cardiology (ESC) and American Society of Hematology (ASH) guidelines recommend against the use of DOACs in all APS patients. The European League Against Rheumatism (EULAR), British Society for Haematology (BSH), and International Society on Thrombosis and Haemostasis (ISTH) guidance provided more detailed indications stating that warfarin should be the first-choice treatment but DOACs may be considered in patients (1) already on a stable anticoagulation with a DOAC, (2) with low-quality anticoagulation by warfarin, (3) unwilling/unable to undergo INR monitoring, (4) with contraindications or serious adverse events under warfarin. Patients with arterial APS or triple positivity should be treated with warfarin while venous APS with single or double positivity may be candidate to DOACs, but high-quality studies are needed.
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Mohamed, M. O., J. C. Lopez-Mattei, C. A. Iliescu, P. Purwani, A. Bharadwaj, P. Y. Kim, N. L. Palaskas, et al. "P681Acute Myocardial Infarction in patients with Leukaemia: A national analysis of prevalence, predictors and outcomes in United States hospitalisations (2004 to 2014)." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz747.0287.
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Abstract Background Patients with leukaemia are at increased risk of cardiovascular events. There is limited outcomes data for patients with a history of leukaemia who present with an acute myocardial infarction (AMI). Purpose To examine the prevalence and clinical characteristics of patients with leukaemia presenting with AMI, and evaluate differences in clinical outcomes according to the subtype of leukaemia in comparison to patients without leukaemia. Methods We analysed the Nationwide Inpatient Sample (2004–2014) for patients with a primary discharge diagnosis of AMI and concomitant leukaemia, and further stratified according to the subtype of leukaemia into 4 groups; AML; ALL; CML; and CLL. Multiple logistic regression was conducted to identify the association between leukaemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. Results Out of 6,750,927 AMI admissions, a total of 21,694 patients had a leukaemia diagnosis. The leukaemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukaemia was independently associated with increased odds of MACCE (OR 1.26 [1.20,1.31]) and mortality (OR 1.43 [1.37,1.50]) without an increased risk of bleeding (OR 0.86 [0.81,0.92]). Acute myeloid leukaemia (AML) was associated with approximately three-fold risk of MACCE (RR 2.81 [2.51, 3.13]) and a four-fold risk of mortality (RR 3.75 [3.34, 4.22]) (Figure 1). Patients with leukaemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukaemia. Figure 1.Relative risk of adverse events Conclusion Patients with leukaemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukaemia. A multi-disciplinary approach between cardiologists and haematology oncologists may improve the outcomes of patients with leukaemia after AMI.
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Shabbir, A., C. Lau, K. S. Rathod, I. Chhetri, A. Haque, T. Godec, R. S. Khambata, V. Kapil, and A. Ahluwalia. "Inorganic nitrate attenuates the systemic inflammatory response in typhoid vaccine-induced endothelial dysfunction in healthy volunteers." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.3009.
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Abstract Background Inflammatory responses underlie the development of endothelial dysfunction in CVD, however, therapeutics that might target this pathway have not been forthcoming. A key pathogenic mechanism mediating endothelial dysfunction is a reduction in bioavailable (eNOS-derived) nitric oxide (NO). Activation of the non-canonical pathway for in-vivo NO generation might offer an approach to improve NO levels and recover vascular function in pre-clinical models of CVD. Whether this might occur in humans is unknown. Purpose We hypothesize that consumption of inorganic nitrate will lead to increases in bioavailable NO and thus attenuate the inflammatory pathways leading to typhoid vaccine-induced endothelial dysfunction in healthy volunteers. Methods Healthy male volunteers were recruited (n=78) and randomized to receive either beetroot juice containing 8–10mmol nitrate or placebo (nitrate-deplete) juice once daily for 6 days. Participants underwent serial measurements of BP, FMD and GTN-induced brachial artery dilatation, and haematology and biochemistry, before and after typhoid vaccination. Blood, urine and saliva nitrite and nitrate were quantified using ozone chemiluminescence, and leukocyte flow cytometry analysis was conducted. Results 8-hours post-vaccine endothelial function was depressed in placebo-treated volunteers, however this was prevented in nitrate-treated volunteers. This dysfunction was due to impaired endothelial function since responses to GTN were unaffected either by vaccination or dietary intervention (p=0.981). Dietary nitrate resulted in an increase in plasma (p<0.0001), urine (p=0.0006) and saliva (p<0.0001) nitrate, and urine (p=0.0354) and saliva (p<0.0001) nitrite levels. There was a reduction in the proportions of CD14++/CD16+intermediate monocytes in nitrate-treated participants after vaccine (p=0.016, change from baseline between groups). In the nitrate-treated group, less CD14++/CD16+ intermediate monocyte CD62L expression was identified post-vaccine (p=0.0122), compared to placebo, with no difference in soluble plasma CD62L between groups (p=0.875). CD11b median fluorescence intensity was increased in CD3+/CD4+ T-lymphocytes in nitrate-treated volunteers (p=0.0095). Conclusions Dietary nitrate reduced BP, as previously shown, indicating efficacy of the intervention. Importantly, we also now show for the first time that inorganic nitrate suppresses the systemic inflammatory response, specifically by reducing the numbers and activation state of CD14++/CD16+ intermediate monocytes. Furthermore, an increased expression of CD3+/CD4+ T-cell CD11b and preserved FMD in healthy volunteers treated with nitrate, suggests an anti-inflammatory phenotype, induced by the intervention, leading to improved endothelial function. Inorganic dietary nitrate modulates endothelial function through the attenuation of inflammatory responses and may be of potential therapeutic benefit in patients with established CAD. Funding Acknowledgement Type of funding sources: None.
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Oridupa, Olayinka Ayotunde, Ademola Adetokunbo Oyagbemi, Olumuyiwa Adejumobi, Folusho Bolawaye Falade, Ayobami Deborah Obisesan, Bukola Adedayo Abegunde, Precious Chima Ekwem, Victor Oluwaseun Adegboye, and Temidayo Olutayo Omobowale. "Compensatory depression of arterial pressure and reversal of ECG abnormalities by Annona muricata and Curcuma longa in hypertensive Wistar rats." Journal of Complementary and Integrative Medicine, May 20, 2021. http://dx.doi.org/10.1515/jcim-2020-0280.
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Abstract Objectives Increasing hypertension incidence in Sub-Sahara Africa and the current cost of management of the metabolic disorder has necessitated research on medicinal plants employed in African Traditional Medicine for hypertension. Thus, this study evaluated antihypertensive effect of Annona muricata leaves or Curcuma longa rhizomes in experimentally-induced hypertensive male Wistar rats (n=70) which were unilaterally nephrectomized and daily loaded with 1% salt. Cardiovascular and haematological changes, as well as urinalysis were determined. Methods Rats were uninephrectomized and NaCl (1%) included in drinking water for 42 days. Extract-treated hypertensive rats were compared to normotensive, untreated hypertensive and hypertensive rats treated with lisinopril (5 mg/70 kg) or hydrochlorothiazide (12.5 mg/70 kg). A. muricata extract or C. longa extract were administered at 100, 200 or 400 mg/kg. Blood pressure (systolic, diastolic and mean arterial) and electrocardiogram was measured on day 41. Twenty-four-hour urine samples were collected from day 42. Blood samples were collected on day 43 for haematology (PCV, red cell indices, WBC and its differentials, and platelets). Results and Conculsions A. muricata or C. longa extracts caused a decline in elevated blood pressure of hypertensive rats. Heart rate and QT segment reduction coupled with prolonged QRS duration were reversed in extract-treated rats, with significant increases in hemogram parameters indicating increased blood viscosity. Also, leukocyturia, proteinuria and ketonuria with increased urine alkalinity, urobilinogen and specific gravity which are classical indicators of poor prognostic outcomes in hypertension were reversed in extract-treated rats. In conclusion, A. muricata and C. longa have cardioprotective effect with reversal of derangements in haemogram and urinalysis associated with hypertension.
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Lopez, Faye L., Sunil K. Agarwal, Elsayed Z. Soliman, Laura R. Loehr, Pamela L. Lutsey, Lin Y. Chen, Rachel R. Huxley, and Alvaro Alonso. "Abstract P109: Serum Phosphorus Levels and the Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study." Circulation 125, suppl_10 (March 13, 2012). http://dx.doi.org/10.1161/circ.125.suppl_10.ap109.
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Background - Several traditional cardiovascular risk factors, including hypertension, diabetes, and obesity have been associated with the risk of atrial fibrillation (AF). Literature on non-traditional risk predictors for AF is scarce, but high phosphorus, which has been linked with calcification and higher cardiovascular morbidity and mortality both in those with and without kidney dysfunction, may be one such marker. We assessed whether serum phosphorus levels were associated with AF incidence in a large community-based cohort in the US. Methods - Our analysis included 14,693 participants (25% African-American, 45% men) free of AF at baseline (1987-89), and with measurements of fasting serum phosphorus from the Atherosclerosis Risk in Communities (ARIC) study. Incidence of AF was ascertained through the end of 2008 from study visit ECGs, hospitalizations and death certificates. Cox proportional hazard models were used to estimate the hazards ratios (HR) of AF by serum phosphorous levels, adjusting for potential confounders. Results - During a median follow-up of 19.7 years, we identified 1659 incident AF cases. Higher serum phosphorus was associated with higher AF risk: multivariable HR: 1.20, 95% confidence interval (CI) 1.02-1.42 comparing extreme quintiles, p for trend=0.009 ( table ). The HR (95% CI) of AF with a 1 mg/dL increase in serum phosphorus was 1.15 (1.04-1.28). No significant interaction was seen by race (p=0.92) or gender (p=0.62). A possible interaction was seen between eGFR and phosphorus quintiles (p=0.05), with an increased risk of AF associated with higher serum phosphorus in those with eGFR =>90 mL/min/1.72m² but not among those with eGFR<90 ( table ). Conclusion - In this large population-based study, higher levels of serum phosphorus were associated with a higher incidence of AF. The association was seen only in those with normal kidney function. Table. Multivariable hazard ratio (95% confidence interval) of atrial fibrillation by quintiles of serum phosphorus levels, ARIC, 1987-2008 Serum Phosphorus Quintiles (mg/dL) P for trend ≤3.0 3.1-3.3 3.4-3.5 3.6-3.8 ≥3.9 Total population N (14,693) 3201 3287 2483 3048 2674 AF cases 380 373 260 360 286 Hazard Ratio (95% CI) * 1 (Ref.) 1.09 (0.94-1.26) 1.06 (0.90-1.25) 1.22 (1.05-1.42) 1.20 (1.02-1.42) 0.009 eGFR = > 90 mL/min/1.72m² N (10,149) 2143 2279 1723 2160 1844 AF cases 226 223 155 229 189 Hazard Ratio (95% CI) * 1 (Ref.) 1.06 (0.88-1.28) 1.01 (0.82-1.25) 1.26 (1.04-1.52) 1.37 (1.11-1.69) 0.001 eGFR <90 mL/min/1.72m² N (4544) 1058 1008 760 888 830 AF cases 154 150 105 131 97 Hazard Ratio (95% CI) * 1 (Ref.) 1.11 (0.88-1.39) 1.14 (0.88-1.39) 1.17 (0.91-1.49) 1.01 (0.77-1.32) 0.69 * Cox proportional hazard models adjusted for baseline age, gender, race, education, ARIC center, height, income, smoking status, drinking status, BMI, systolic blood pressure, diastolic blood pressure, antihypertensive medications, diabetes, serum calcium, estimated glomerular filtration rate (eGFR), prevalent stroke, prevalent heart failure and prevalent coronary heart disease Funding(This research has received full or partial funding support from the American Heart Association, National Center)
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Jaipurkar, Raksha, Swapnil Saikhedkar, Dharmendra Kumar, Gaurav Sikri, and Sushil Sharma. "Art of Paper Setting: The Blueprinting of MBBS Physiology Competency Based Curriculum." JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021. http://dx.doi.org/10.7860/jcdr/2021/48372.15118.
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Introduction: Written examinations are integral component of students’ assessments at formative and summative level. There is no blueprint of question paper available for the new curriculum in Bachelor of Medicine and Bachelor of Surgery (MBBS) Physiology curriculum which may lead to variations in question paper setting. This lack of consistency in question papers affects the preparedness and performance of students. Aim: To prepare the blueprint of MBBS Physiology Competency Based Medical Education (CBME) curriculum and to do content validity by comparing with Preliminary Examination (PE) and University Examination (UE). Materials and Methods: This was a descriptive study conducted over a period of six months from July 2020 till December 2020. The study was conducted in Armed Forces Medical College, Pune. There are 15 topics and 140 outcomes for Physiology MBBS course as per new CBME curriculum is divided into paper I and II according to Maharashtra University of Health Sciences (MUHS) syllabus. The main topics in each paper were further subdivided into subtopics for preparing learning objectives. Marks were allotted to each system taking into consideration optimum marks 97 for subjective with included options and 20 marks Multiple Choice Questions (MCQs). The papers of UE and PE conducted with new format were analysed for content validity. Results: The blueprint of paper I (subjective) shows marks allotted for General Physiology 12, Haematology 13, Respiratory System (RS) 15, Cardiovascular (CVS) 17, Exercise 05, Renal system 15, Gastrointestinal System (GIT) 12, Lifestyle Aging and Meditation 03 and Attitude, Ethics and Communication. (AETCOM) 05 marks. The blueprint of paper II (subjective) shows marks for the Nerve-Muscle 16, Central Nervous System (CNS) 25, Special senses 14, endocrine system are 18, reproductive system 15, and temperature 09. MCQs were also allotted proportionate marks for each topic. Content analysis of papers showed exercise Physiology and body temperature regulation were not assessed in UE. Conclusion: There was disproportionate representation of topics in formative and summative examinations in absence of blueprint. The blueprint should be an integral part of assessments.
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Joy, G., JD Crane, JB Augusto, C. Lau, A. Seraphim, A. Bhuva, JC Moon, et al. "Microvascular and mechanical improvements following bariatric surgery in the obese; mechanistic insights from advanced & automated quantitative perfusion cardiac MRI." European Heart Journal - Cardiovascular Imaging 22, Supplement_1 (January 1, 2021). http://dx.doi.org/10.1093/ehjci/jeaa356.298.
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Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Guy"s and St Thomas" Charity University College London Hospital Biomedical Research Centre Background In people with obesity, bariatric surgery reduces mortality, heart failure and coronary disease, improving metabolic (blood sugar, lipid profile, inflammation) and cardiovascular (diastolic/systolic function, filling pressure, cardiac remodelling) parameters. Myocardial microvascular function is a candidate causal link of metabolic to structural cardiac abnormalities. Purpose We hypothesised that bariatric surgery could improve myocardial microvascular and mechanical function in both those with and without diabetes. Methods Before and six months after bariatric surgery, 24 subjects with obesity were assessed with haematology, biochemistry and advanced CMR (cines, vasodilator adenosine stress and rest fully-automated quantitative perfusion mapping, tissue-tracking (CVI42, post processing). Results. Mean age was 49± 12 years, 35%(8) were male, 63%(15), had hypertension, 17 (71%) had diabetes. Surgery resulted in decreases in BMI (44 ± 7 to 34 ± 6 kg/m2 p = 0.0001) and HbA1c (57 ± 16 to 42 ± 9mmol/mol p = 0.0001). EF% and absolute LV end-diastolic volumes remained unchanged, but mass regressed and myocardial contraction fraction (ratio of stroke volume and LV volume) increased (see Table). There were also strain improvements (radial 35 ± 8.8 to 37.3 ± 8.7 %p = 0.029) (circumferential -19.8 ± 2.3 vs -20.7 ± 3% p = 0.017), although longitudinal did not improve (-16.3 ± 3.2 to -15.9 ± 3% p = 0.25). Myocardial perfusion significantly improved (stress myocardial blood flow, MBF 2.35 ± 0.71 to 2.80 ± 0.98 ml/g/min p = 0.008; myocardial perfusion reserve MPR 2.47 ± 0.78 to 2.97 ± 0.95 p = 0.005). Improvement in stress MBF and MPR from pre-operative to post-operative was higher in the non-diabetics (n = 7 (29%)) than the diabetics (n = 17 (71%)) (stress MBF: 1.15 ± 1.00 vs 0.16 ± 0.39ml/g/min p = 0.002) MPR: (1.09 ± 0.73 vs 0.25 ± 0.66 p = 0.011). Conclusion At 6 months, bariatric surgery results in beneficial myocardial remodelling and substantial improvements in myocardial microvascular function. These improvements occur most in those without diabetes suggesting that there may be reversible and irreversible components to microvascular dysfunction. Perfusion and strain variables Variable Pre-op (n = 24) Post-op (n = 24) p-value LVEDV (ml) 163 ± 28 161 ± 29 0.64 EF (%) 70 ± 8 70 ± 7 0.78 Stroke volume (ml) 113 ± 19 111 ± 21 0.6 LV Mass (g) 117 ± 25 103 ± 21 0.001 Myocardial contraction fraction 94 ± 14 105 ± 14 0.001 LVEDV - left ventricular end-diastolic volume, EF - ejection fraction Abstract Figure.
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Demetriades, P., V. Ahluwalia, L. Speke, L. Wilson, and J. N. Khan. "P731 When cardiac imaging saves the day - a rare cause of embolic stroke." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.402.
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Abstract INTRODUCTION Hypereosinophilic syndrome (HES) is a rare disorder characterised by infiltration of tissues by eosinophils. Myocardial infiltration occurs in 50-60% of HES and leads to a condition called Loeffler’s endocarditis. Eosinophilic protein toxicity initiates endomyocardial necrosis. This is followed by a thrombotic stage and finally by endomyocardial fibrosis leading to a form of restrictive cardiomyopathy. Thrombosis is often located in the apical region of the ventricles and can result in stroke, which is the most devastating neurological consequence of hyperoesinophilia. We describe a case of a patient that presented with neurological symptoms and was found to have multiple embolic strokes secondary to Loeffler’s endocarditis. CASE A 57-year-old female presented to our institution with new onset confusion and reduced level of consciousness. Initial neurological assessment was consistent with encephalopathy. She had a 2-year history of eosinophilia that had been investigated by the haematology and rheumatology teams with no obvious aetiology identified. Initial haematological investigations showed a raised eosinophil count at 13mmol/L. Her cerebral MRI scan showed multiple embolic infarcts and therefore a transthoracic echo (TTE) was booked. This did not show any obvious intracardiac cause of emboli although the appearances of the LV apex were suspicious of thrombus. This was confirmed later, on contrast imaging (Fig 1). Staphylococcus aureus was grown in a single blood culture specimen raising the suspicion of infective endocarditis and a transoeosophageal echocardiogram (TOE) ruled out vegetations but again illustrated the apical filling defect despite absence of wall motion abnormalities (Fig 2). Finally, a cardiac MRI was arranged and this confirmed the diagnosis of Loeffler’s endocarditis with endomyocardial fibrosis and superimposed LV thrombus (Fig 3). She was treated with anticoagulation and steroids and her eosinophil count normalised before discharge. She remains well with no recurrence at two months post-event. DISCUSSION The diagnosis of Loeffler’s endocarditis depends on the presence high eosinophil count in combination with cardiac involvement on imaging. Transthoracic echocardiography can provide useful information such as apical thickening and thrombus in the left ventricle. As in our case, contrast TTE often provides further detail however contrast-enhanced cardiac MRI remains a key tool in the diagnosis and monitoring of this condition. It provides an assessment of systolic and diastolic function, tissue characterisation and typical features notably endomyocardial fibrosis and thrombosis on late enhancement imaging. CONCLUSIONS We presented a case where cardiac imaging has revealed the diagnosis in a patient presenting with systemic symptoms. We encourage clinicians to use multi-modality cardiac imaging as this has an invaluable role in the diagnostic process of complex patients. Abstract P731 Figure.
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Левшин, Н. Ю., Е. В. Ройтман, А. В. Аршинов, and В. М. Печенников. "Dipyridamole: the rearguard on proscenium." Тромбоз, гемостаз и реология, no. 2(78) (July 16, 2019). http://dx.doi.org/10.25555/thr.2019.2.0875.
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Антиагрегантная терапия является основой профилактики атеротромбоза и нарушений микроциркуляции при многих видах патологии. Дипиридамол в сочетании с ацетилсалициловой кислотой служит важным компонентом профилактики ишемического инсульта он также доказал свою эффективность в улучшении коронарного кровотока, периферического кровообращения за счет своего антиагрегантного и сосудорасширяющего действия. Синдром обкрадывания является клиническим преувеличением, так как присущ только высоким дозам препарата, вводимым внутривенно. Дипиридамол обладает многими плейотропными эффектами, связанными с его способностью индуцировать синтез интерферона, регулировать оксидативный стресс, активность клеток иммунной системы, матриксных металлопротеиназ и др. Понимание патогенеза различных видов патологии с позиций взаимосвязи гемостаза и воспаления наряду с высокой безопасностью дипиридамола в отношении кровотечений, онкологического роста и его экономической доступностью позволяют применять препарат в ревматологии, акушерстве и гинекологии, нефрологии, гематологии и других областях медицины, проводить актуальные научные исследования. Обзор посвящен обсуждению возможностей коррекции ключевых механизмов патогенеза многих заболеваний с использованием различных свойств дипиридамола и применения данных преимуществ препарата в клинике внутренних болезней. Antiplatelet agents are the main group of drugs using for antiatherothrombotic prophylaxis and correction of microcirculatory disturbances in many fields of medicine. Dipyridamole in combination with acetylsalicylic acid is an important component of stroke prevention. It also demonstrates effectiveness for prevention of cardiovascular complications due to its antiplatelet and vasodilatory effect. Steal phenomenon is clinical exaggeration, because it happens only if high doses of dipyridamole are injected intravenously. Dipyridamole has numerous pleiotropic effects related with its ability to induce interferon synthesis, to regulate oxidative stress, activity of immune cells, matrix metalloproteinases, etc. Understanding of pathogenesis of numerous diseases as the interrelationship between hemostasis and inflammation may leads medical specialists to use dipyridamole in rheumatology, obstetrics, gynecology, nephrology, haematology and other fields of medicine and medical researches. High safety of dipyridamole in regard to hemorrhagic complications, malignant progression and its high economic accessibility are very important features of this wellknown for clinicians drug. Further search of clinical applications for dipyridamole is discussed in this review.