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Journal articles on the topic 'Obesity, arterial hypertension, type 2 diabetes, nursing care'

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Published: 24 April 2022

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1

Carolino, Idalina Diair Regla, Carlos Alexandre Molena-Fernandes, Raquel Soares Tasca, Sonia Silva Marcon, and Roberto Kenji Nakamura Cuman. "Risk factors in patients with type 2 diabetes mellitus." Revista Latino-Americana de Enfermagem 16, no. 2 (April 2008): 238–44. http://dx.doi.org/10.1590/s0104-11692008000200011.

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This study was carried out to evaluate the risk factors of type 2 diabetic patients through sociodemographic data, habits of health, anthropometric and biochemist profiles, assisted at a basic public health care unit in Maringá, Paraná. Sixty-six patients, 56 women aged over than 50 years-old were interviewed. High prevalence factors for cardiovascular risk were observed, such as: overweight and obesity, hypertension, dyslipidemia, sedentariness and inadequate diet. Data suggested the need for multidisciplinary intervention programs in health care units associated to educative programs, adjusted diet intake and regular physical activity for these diabetic patients.
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Lima, Adman Câmara Soares, Márcio Flávio Moura Araújo, Roberto Wagner Júnior Freire de Freitas, Maria Lúcia Zanetti, Paulo César de Almeida, and Marta Maria Coelho Damasceno. "Risk factors for Type 2 Diabetes Mellitus in college students: association with sociodemographic variables." Revista Latino-Americana de Enfermagem 22, no. 3 (June 2014): 484–90. http://dx.doi.org/10.1590/0104-1169.3053.2441.

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OBJECTIVE: identify the modifiable risk factors for type 2 diabetes mellitus in college students and associate these factors with their sociodemographic variables.METHOD: cross-sectional study, involving 702 college students from Fortaleza-CE, Brazil. Sociodemographic, anthropometric, physical exercise data and blood pressure and fasting plasma glucose levels were collected.RESULTS: the most prevalent risk factor was sedentariness, followed by overweight, central obesity, high fasting plasma glucose and arterial hypertension. A statistically significant association was found between overweight and sex (p=0.000), age (p=0.004) and marital status (p=0.012), as well as between central obesity and age (p=0.018) and marital status (p=0.007) and between high fasting plasma glucose and sex (p=0.033).CONCLUSION: distinct risk factors were present in the study population, particularly sedentariness and overweight.
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Silva, Lorena Rodrigues da, Sidnéia Sousa Silveira, Roberto Wagner Júnior Freire de Freitas, Vanessa Emille Carvalho de Sousa, Izabel Cristina Falcão Juvenal Barbosa, and Marta Maria Coelho Damasceno. "Risk factors for diabetes mellitus type 2 in nursing students." Revista de Enfermagem UFPE on line 5, no. 3 (April 23, 2011): 757. http://dx.doi.org/10.5205/reuol.1262-12560-1-le.0503201126.

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ABSTRACTObjective: to investigate the prevalence of risk factors for diabetes mellitus type 2 among nursing students. Method: a cross-sectional study was developed in the first semester of 2009 with 99 nursing students, of both sexes, in a nursing college of Fortaleza/Ceará. Data were collected with a formulary regarding sociodemographic factors, anthropometric data, physical activity information, blood pressure levels and the capillary glycemia. The data was analyzed by the Statistical Software Package for the Social Sciences (SPSS), version 16.0. The study was approved by the committee of ethics in research involving humans of the mentioned college through the protocol number 011/2009. Results: a large portion of the sample (46.5%) presented Overweight/obesity, 74,7% presented sedentaryism, 14.1% presented prehypertension, 14.1% presented hypertension and 1% had high capillary glycemia. Conclusions: the study showed that nursing students that participated in the survey presented different risk factors for diabetes mellitus type 2. It reinforces the importance of emphasize the prevention of this illness. Descriptors: diabetes mellitus; risk factors; students.RESUMOObjetivo: investigar a prevalência dos fatores de risco para diabetes mellitus tipo 2 entre acadêmicos de enfermagem. Método: estudo quantitativo, transversal, desenvolvido no primeiro semestre de 2009 com 99 estudantes, de ambos os sexos e devidamente matriculados no curso de bacharelado em enfermagem de uma faculdade de Fortaleza-Ceará. Para a coleta de dados foi aplicado um formulário com informações de dados sociodemográficos, antropométricos, referentes à prática de atividade física, à pressão arterial e à glicemia capilar. Os dados foram armazenados em um banco e analisados por meio do software Statistical Package for the Social Sciences, versão 16.0. O estudo foi apreciado pelo Comitê de Ética em Pesquisa Envolvendo Seres Humanos da Faculdade Integrada do Ceará e aprovada através do protocolo n. 011/2009. Resultados: Grande parcela da amostra, 46,5%, apresentava sobrepeso/obesidade, 74,7% sedentarismo, 14,1% foram classificados como pré-hipertensos, 14,1% como hipertensos e 1% apresentou glicemia capilar elevada. Conclusões: o estudo mostrou que os estudantes de enfermagem, que participaram da pesquisa, possuíam uma série de fatores de risco para o desenvolvimento do diabetes mellitus tipo 2 e reforça, ainda, a importância da conscientização destes indivíduos quanto às medidas preventivas da enfermidade. Descritores: diabetes mellitus; fatores de risco; estudantes.RESUMENObjetivo: investigar la prevalencia de factores de riesgo para la diabetes mellitus tipo 2 entre académicos de enfermería. Método: estudio transversal, desarrollado en la primera mitad de 2009 con 99 alumnos de ambos sexos y debidamente inscritos en un curso de enfermería de Fortaleza-Ceará. Para recoger los datos, se aplicó un formulario con informaciones socio demográficas, datos antropométricos, datos relativos a la práctica de la actividad física, a la presión arterial y a la glucemia capilar. Los datos fueron almacenados y analizados a través del Statistical Package for the Social Sciences, versión 16.0. El estudio fue examinado por el Comité de ética en Pesquisas con seres humanos de la institución y fue aprobado a través del protocolo numero 011/2009. Resultados: una gran parte de la muestra, 46,5%, presentó sobrepeso y obesidad, 74,7% presentaron sedentarismo, 14,1% presentaron pre-hipertensión, 14,1% presentaron hipertensión y 1% fueron clasificados como portadores de glucemia capilar alta. Conclusiones: el estudio demostró que los estudiantes de enfermería que participaron del estudio tuvieron una serie de factores de riesgo para el desarrollo de diabetes mellitus tipo 2. Esto refuerza la importancia de la toma de conciencia de estos individuos en relación a las medidas de prevención de esta enfermedad. Descriptores: diabetes mellitus; factores de riesgo; estudiantes.
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Heredia, Mariel, and Esther Carlota Gallegos Cabriales. "Riesgo de diabetes mellitus tipo 2 y sus determinantes." Enfermería Global 21, no. 1 (January 1, 2022): 179–202. http://dx.doi.org/10.6018/eglobal.482971.

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Objective: Describe the relationship between social determinants of health and risk of type 2 diabetes mellitus in Mexican population.Methods: This was a cross-sectional descriptive correlational study of a sample of 256 individuals from a rural community in Sinaloa, Mexico. Data collection was carried out from October 2020 to February 2021. A snowball non-probability sampling method was used. The Instruments used were the International Physical Activity Questionnaire (IPAQ), short version, the IPAQ-A for adults, the IPAQ-C for children, and a sociodemographic, anthropometric, and clinical data sheet.Results: The most frequent risk indicators for T2DM for adults are hypertension (81.7%) and overweight/obesity (68.6%); in children, it was overweight/obesity (34.9%). The risk of T2DM increased according to age (r = .560, p < .01) but decreased as education level increased (r = −.127, p < .05)Conclusions: The approach to T2DM risk factors from the perspective of social determinants of health allows strategic healthcare planning that considers the contextual factors associated with a lifestyle that reinforces the actions of healthcare providers. Objetivo: Describir la relación de los determinantes sociales de salud con el riesgo de DMT2 en población mexicana.Métodos: Estudio descriptivo correlacional transversal, con una muestra de 256 individuos de una comunidad rural de Sinaloa, México. La recolección de datos se realizó durante octubre de 2020 y febrero de 2021. El muestreo fue no probabilístico por bola de nieve. Los instrumentos utilizados fueron el cuestionario internacional de actividad física (IPAQ) versión corta, IPAQ-A, IPAQ-C y una hoja de registro datos sociodemográficos, antropométricos y clínicos.Resultados: Los indicadores de riesgo de DMT2 con mayor frecuencia para adultos fue padecer hipertensión arterial (81.7%) y SP/OB (68.6%) y para menores de edad fue tener SP/OB (34.9%). Resultó que el riesgo de DMT2 se acrecentaba según lo hacía la edad (r = .560, p < .01) pero disminuía al aumentar la escolaridad de las personas (r = -.127, p < .05).Conclusiones: El abordaje de factores de riesgo de DMT2 bajo la perspectiva de los DSS brinda la oportunidad de plantear estrategias de salud que contemplen factores contextuales simultáneos al estilo de vida que refuercen las acciones del personal de salud para contribuir a la reducción de los índices de morbimortalidad causados por la DMT2.
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Pontiroli, A. E., F. Folli, M. Paganelli, G. Micheletto, P. Pizzocri, P. Vedani, F. Luisi, L. Perego, A. Morabito, and S. Bressani Doldi. "Laparoscopic Gastric Banding Prevents Type 2 Diabetes and Arterial Hypertension and Induces Their Remission in Morbid Obesity: A 4-year case-controlled study." Diabetes Care 28, no. 11 (October 25, 2005): 2703–9. http://dx.doi.org/10.2337/diacare.28.11.2703.

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Bhat, Sajad Hussain, Mohd Yousuf Dar, and Aadil Majeed. "Study prevalence of peripheral arterial disease in diabetics with coronary artery disease at a large tertiary care teaching hospital in North India." International Journal of Research in Medical Sciences 8, no. 2 (January 27, 2020): 720. http://dx.doi.org/10.18203/2320-6012.ijrms20200263.

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Background: Peripheral arterial disease and coronary artery disease have similar factors. The extent and severity of PAD is significantly associated with presence and severity of CAD.Methods: Patients were interviewed and clinical profile of patients including risk factors of coronary artery disease like diabetes, hypertension, smoking, dyslipidemia, obesity and family history of coronary artery disease were assessed and recorded in the proforma. Information regarding demographics, co morbidity, past history and family history was collected. Physical examination of each patient was carried and basic anthropometric data: height, weight, BMI and blood pressure, peripheral pulses calculated. Investigations both non- invasive and invasive including peripheral angiography were recorded.Results: In this prospective study fifty (50) type 2 diabetes patients admitted with CAD were studied whose mean age was 55.6+8.2 and mean duration of diabetes was 6.8+8.4. In this study none of the patients with PAD had single atherosclerosis risk factors including diabetes. 30% patients were having two risk factors. PAD in in patients with CAD is particularly enhanced by the concomitant occurrence of two or more of these risk factors (p=0.016). Hypertension as a predictor of PAD was statistically significant (p=0.0037). In this study the duration of diabetes was <5 years in 10%, 5-10 years in 40% and >10 years in 40% of patients with angiographically proven PAD.Conclusions: It was observed that presence and severity CAD was significantly associated with PAD.
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Guillen-Aguinaga, Sara, Antonio Brugos-Larumbe, Laura Guillen-Aguinaga, Felipe Ortuño, Francisco Guillen-Grima, Luis Forga, and Ines Aguinaga-Ontoso. "Schizophrenia and Hospital Admissions for Cardiovascular Events in a Large Population: The APNA Study." Journal of Cardiovascular Development and Disease 9, no. 1 (January 13, 2022): 25. http://dx.doi.org/10.3390/jcdd9010025.

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(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.
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Compton, Rebekah M., Kimberly S. Bednar, Peggie E. Donowitz, and M. Norman Oliver. "Management of patients with type 2 diabetes mellitus in the Grand-Aides Program." Journal of Nursing Education and Practice 10, no. 3 (November 18, 2019): 1. http://dx.doi.org/10.5430/jnep.v10n3p1.

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Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p < .001) and diastolic (p < .01) blood pressures decreased (p < .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of >130 mmHg despite treatment; after 12 months, 48 percent of these were < 130. In those whose baseline diastolic blood pressure was > 90 mmHg, 100 percent had diastolic blood pressure < 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p < .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.
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Williams, Bronwen, Nurun Tania, and Lynsey Corless. "Non-alcoholic fatty liver disease (NAFLD): survey of awareness and understanding among professionals in secondary care." Gastrointestinal Nursing 17, Sup6 (July 2019): S22—S29. http://dx.doi.org/10.12968/gasn.2019.17.sup6.s22.

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Background: Non-alcoholic fatty liver disease (NAFLD) refers to a spectrum of hepatic conditions unrelated to alcohol consumption and affects around 30% of the UK adult population. It can progress from steatosis to non-alcoholic steatohepatitis (NASH), increasing the risk of cirrhosis and hepatocellular carcinoma. Methods: To explore baseline understanding and awareness, health professionals in various roles (excluding gastroenterology and hepatology) at a secondary-care teaching hospital in England received a questionnaire consisting of 21 multiple-choice questions, 16 on NAFLD and five on demographics. Results: Roles included qualified nurses, clinicians, non-clinical staff, medical students, student nurses, nursing support workers and allied health professionals. Of these, 85% had heard of NAFLD and 58% of NASH; by role, these numbers ranged from 100% for clinicians and medical students to only 54% and 8% respectively for nursing students. Knowledge of risk factors ranged from 81% for high cholesterol to 12% for depression, and only 9% identified all four features of metabolic syndrome (MetS): obesity, hypertension, dyslipidaemia and type 2 diabetes. Incorrectly identified risk factors were excessive alcohol (41%) and caffeine (18%) intake. Practitioners also reported variable understanding of early symptoms, progression, diagnostic investigations, medical history and occurrence in children. Conclusions: Practitioners were insufficiently aware that NAFLD is a spectrum of disease that is preventable and reversible in early stages. Improved practitioner education should increase early detection and allow holistic, multidisciplinary care for better patient outcomes.
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de Araújo, Francisca Luzia Soares Macieira, Edith Monielyck Mendonça Batista, Gutemberg Fernandes de Araújo, Silvana Maria Mendes Costa, Andréa Karine de Araújo Santiago, and Ana Cláudia Ribeiro Gonçalves. "Características de pacientes superobesos atendidos em serviço de referência em cirurgia bariátrica." Braspen Journal 34, no. 4 (January 20, 2020): 379–83. http://dx.doi.org/10.37111/braspenj.2019344012.

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Introduction: Obesity is a worldwide epidemic and people with super obesity (BMI > 50 kg/m²) have the worse prognosis, related to physical complications but also to mental illnesses, physical and verbal abuse, as well as social exclusion. Objective: To determine the profile of super obese patients treated in a referential bariatric surgery service. Methods: Retrospective analysis of 56 medical records of patients treated at the HUUFMA’s Bariatric and Metabolic Surgery Service multidisciplinary ambulatory care in 2017-2019. Incomplete records or with body mass index (BMI) < 50 kg/m² were excluded. Results are presented in mean and standard deviation. Chi-square test was used for association analysis, Shapiro-Wilks test for normality and significance was considered for p<0.05. Results: Prevalence in sample of females (80.3%), brown skin (67.8%), average age of 37.8 ± 9.8 years, and 49.1% graduated high school. The average weight and BMI were that of 136.6 ± 12.4 kg and 59 ± 6.5 kg/m², respectively, with a patient standing out with a BMI of 71 kg/m². Among the comorbidities we found obstructive sleep apnea in 100%, insomnia in 98.2%, joint problems in 53.5%, anxiety in 50%, hepatic steatosis and systemic arterial hypertension with 48.2% each, dyslipidemia in 42.8%, intestinal constipation in 32.1% and type 2 diabetes mellitus in 17.8%. There was a significant relation (p<0.05) between schooling and weight. An impact on mental health was observed, with 37.5% of the patients exhibiting depression, 44.6% binge eating and 17.6% suicidal thoughts and/or self-mutilation. Conclusion: The super obese patients’ profile is that of a young adult woman, with average schooling, various comorbidities and with significant impact on mental health.
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Ushakov, V. V., E. O. Girfanova, T. V. Zuevskaya, P. I. Pavlov, and E. V. Sadrieva. "Efficacy of hyperbaric oxygenation in the complex treatment of new coronavirus infection COVID-19." Medical Science And Education Of Ural 22, no. 3 (September 30, 2021): 71–75. http://dx.doi.org/10.36361/1814-8999-2021-22-3-71-75.

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Purpose of the study: evaluation of the therapeutic effectiveness of hyperbaric oxygenation in the complex treatment of a new coronavirus infection – COVID-19. Materials and Methods: we studied 190 patients with COVID-19-induced pneumonia (mean age 52.2 ± 2.3 years), the study group (95 patients; 41 women, 54 men) received against the background of complex treatment courses of hyperbaric oxygenation № 3-5; at pressure 1.3-1.4 ATA for 40-60 minutes; comparison group (n = 95; 42 women; 53 men) received standard complex treatment. The concomitant diseases in most patients were: arterial hypertension (stage I-II), obesity (stage II-IV) and type 2 diabetes mellitus. Results: a more pronounced therapeutic effect was noted in the main group of patients: only 3 patients were admitted to the intensive care unit, while in the comparison group – 10 patients, 2 of whom died. The presented data suggest that the use of HBO can quickly achieve correction of hypoxia in patients with new coronavirus infection, improve lung function, as well as improve the course of related diseases, including symptoms related to gastrointestinal pathology, cardiovascular disease, mental conditions, etc., affecting the body as a biostimulant. Conclusion: hyperbaric oxygenation in patients with new coronavirus infection caused by SARS-CoV-2 virus is an effective method and has a multifactorial effect leading both to improvement of subjective state parameters of the examined patients and to increase of hemoglobin oxygen saturation, decrease of lipid peroxidation processes intensity, activation of antioxidant system of the body, restoration of pro- and antioxidants balance, normalization of apoptosis processes.
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Khramchenko, M. A., A. D. Karpenkova, M. M. Petrova, and D. S. Kaskaeva. "Cardiovascular pathology in the clinical practice of primary care physicians on the example of Krasnoyarsk." Siberian Journal of Clinical and Experimental Medicine 35, no. 2 (July 10, 2020): 167–73. http://dx.doi.org/10.29001/2073-8552-2020-35-2-167-173.

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Introduction. Cardiovascular comorbidity is a relevant problem in modern medicine. Comorbid pathology significantly worsens the quality of life and increases the likelihood of death in cardiovascular patients. The combination of diseases requires a comprehensive examination of the patient and the choice of optimal therapy. This work reviews the structure of cardiovascular comorbidity in outpatient patients of Krasnoyarsk, analyzes the most frequently prescribed medications, and makes conclusions about the need to highlight the problems of combined pathologies in outpatient practice.Aim. To study the structure of cardiovascular comorbidity in outpatient patients in the city of Krasnoyarsk, to assess the frequency of comorbid pathologies in cardiovascular patients, and to analyze the extent of the prescribed therapy.Material and Methods. A one-stage retrospective study analyzed 1,928 ambulatory medical charts of cardiovascular patients who visited the primary care physicians in the polyclinics of Krasnoyarsk in 2018. The material was statistically processed, and diff erences were considered statistically significant at p < 0.05.Results. The prevalence of comorbid pathologies in cardiovascular patients reached 87% and tended to rise with the patients’ age. The study showed that coronary heart disease (CHD) and obesity were associated with type 2 diabetes mellitus (T2DM) in agreement with results reported in previous studies. 43.2% of patients achieved a blood pressure level (BP) < 140/80 mm Hg while on antihypertensive therapy. 46.8% of patients achieved total cholesterol (TCh) < 5.0 mmol/L while taking statins. Only 18.5% of T2DM patients and 15.9% of patients with chronic kidney disease (CKD) who were taking statins had TCh < 4.5 mmol/L. Heart rate (HR) < 70 bpm was reached in about 40% of patients taking b-blockers.Conclusions. Comorbidity prevalence among cardiovascular patients of Krasnoyarsk city was high and tended to increase with the increase in patient age. Arterial hypertension (AH) and T2DM was the most frequent combination among patients with cardiovascular diseases (CVD). Administered antiplatelet, hypolipidemic, and antihypertensive therapies did not fully comply with the current clinical recommendations in regard to the regimen of administration, dosage, and rates of the treatment targets achieved. The study showed that cardiovascular diseases are most frequently combined with T2DM. In this regard, it is necessary to promote the population awareness of the primary and secondary prevention of these comorbid diseases.
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Swaid, Bakr. "Accelerated Progression of Prediabetes to Insulin-Dependent Diabetes After 9 Cycles of Nivolumab." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A363. http://dx.doi.org/10.1210/jendso/bvab048.739.

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Abstract Introduction: Diabetes mellitus have been reported in around 1% of patients receiving immune checkpoint inhibitors (ICI) resultingin immune checkpoint inhibitor induced diabetes mellitus (ICI-DM). 4 phenotypes of ICI-DM exist: acute autoimmuneinsulin-dependent diabetes, decompensation of prediabetes or type 2 diabetes, autoimmune pancreatitis, andautoimmune lipoatrophy. Clinical Case: A 52-year-old man was diagnosed with stage IIIb malignant melanoma. Two months following local excision, he wasstarted on nivolumab every 4 weeks planned for 1 year. His past medical history was significant for prediabetes,hypertension, obesity (BMI 33.27 kg/m²), primary hypogonadism, adult attention deficit disorder, obstructive sleepapnea, gastric ulcer, and gastroesophageal reflux disease. He denied tobacco use but reported semi-daily use ofmarijuana and alcohol. His baseline HbA1c was 6.0%. After the 8th cycle of nivolumab, he reported several bloodglucose readings in the 200 mg/dL range. He was thought to have progressed to type 2 diabetes and metformin wasstarted. Glipizide was added shortly thereafter due to persistent hyperglycemia. At the 9th cycle of nivolumab, hisHbA1c was 8.2%. In 1 week from this time, the patient developed abdominal pain, nausea, and persistent vomiting. Hewas found to be in DKA with blood glucose of 278 mg/dL, bicarbonate of 9.3 mmol/L, anion gap of 21, and arterial pHof 7.22. He was treated in the ICU per standard DKA care. His C-peptide was 0.5 ng/mL (reference 0.8–3.5) withconcomitant plasma glucose of 229 mg/dL. Autoantibody screening was negative including glutamic aciddecarboxylase antibody (anti-GAD), insulin antibody, insulin antigen-2 (IA-2) autoantibody, and zinc transporter 8antibody. The patient was discharged home on multiple daily injections of insulin but he struggled with diabetes carewhich proved to be of brittle nature requiring CGM use. Two months after completion of nivolumab treatment, thepatient reported epigastric abdominal pain with frequent nausea and occasional vomiting of few weeks duration. He wasdiagnosed with subacute pancreatitis based on symptoms and elevated lipase. There was no evidence of gallstones. Although immunotherapy-related pancreatitis was considered, we decided to try alcohol cessation first hoping to avoidthe need to use prednisone. Over several weeks, lipase normalized and his symptoms completely resolved. Conclusion: In this case, nivolumab resulted in progressive beta-cell failure and complete insulin dependence in a person with ahistory of prediabetes. Not all pancreatitis cases in the settings of immunotherapy use are immune-related adverseevents (irAE). Usual causes, e.g. alcohol, should still be considered. With cessation of alcohol, pancreatitis fullyresolved leading to avoidance of prednisone which would likely have worsened diabetes management in this patientwith brittle diabetes.
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Đorđević, Marina, Jelica Davidović, Radmila Resimić, Dijana Otašević, Nataša Marković-Nikolić, and Aleksandar Davidović. "The importance of GRACE score in health care planning of patients after acute myocardial infarction." Sestrinska rec 24, no. 82 (2021): 34–38. http://dx.doi.org/10.5937/sestrec2182034q.

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Introduction: Acute myocardial infarction (AIM) is ischemic myocardial necrosis and is associated with a number of adverse outcomes that complicate patient health care. Assessment of patient status, risk factors, and adverse outcomes has a significant impact on patient care planning after AIM. The GRACE (Global Registry of Acute Coronary Events) score is of great importance in risk stratification in these patients. Objective: To determine the importance of determining the GRACE score in order to set priorities in the planning of patient care after acute myocardial infarction. Method: A retrospective study examined 50 patients, both sexes, aged 28 to 75 years, with a diagnosis of acute myocardial infarction, undergoing percutaneous coronary intervention (PKI), who were treated at the Zvezdara Clinical Hospital in Belgrade during the research period, from January to March 2020. Data were taken from the medical records of these patients. During the study, AIM type, comorbidities, CVD risk factors, GRACE score and frequency of complex nursing interventions in patients with low, moderate, and high-risk of adverse cardiac events were monitored. Results: Out of a total of 50 examinees with AIM treated with PKI, 74% had STEMI and 26% NSTEMI. 84% of patients had positive family history, 64% hypertension, 2% diabetes, 48% obesity, 52% were smokers and 6% of them were using alcohol. The values of the GRACE score were increased as follows: in four patients more than 140, while in one of them a moderate value was recorded, and in one low value of the GRACE score. In the course of six months, three patients, who had high GRACE scores on hospitalization, had a lethal outcome. Complex nursing interventions in the intensive care unit are more common in patients who have high GRACE score values after AIM. Conclusion: The GRACE score can be used as an important guideline in planning the health care of patients after an acute myocardial infarction.
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Shrivastava, Trilok, Miguel Salazar, Victor Prado, Estefania Gauto, Binav Baral, Shristi Upadhyay, and Maha A. T. Elsebaie. "Thirty day readmissions and outcomes following radical nephrectomy in renal cell carcinoma: A nationwide analysis." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e16560-e16560. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e16560.

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e16560 Background: Nephrectomy is one of the primary treatments of Stage I-III renal cell carcinoma (RCC), which is usually associated with low rates of serious morbidity and mortality. However, a fraction of patients gets readmitted after the surgery for numerous reasons which can impact their overall prognosis. Methods: We conducted a retrospective cohort study using the 2017 National Readmission Database of adult patients with RCC readmitted within 30 days after an index admission for nephrectomy. We aimed to identify the 30-day readmission rate, mortality, resource utilization, and independent predictors of readmission. Results: A total of 25,307 patients with RCC underwent nephrectomy. The 30-day readmission rate was 8.7%. The top five causes for readmission were sepsis, AKI, STEMI, surgical infections & metastatic disease. Patients requiring readmission were less likely to be discharged home (56.5 vs 81.8%), have private insurance (27.2 vs 34.7), obesity (14.7 vs 20.6%), hypertension (30.9 vs 47.1%), and be admitted to a teaching hospital (75.8 vs 79.2%). They were more likely to be insured with Medicare (58.3 vs 53.3%), have lower income (28.7 vs 26.3%), type 2 diabetes (32.4 vs 26.7%), CKD (44.1 vs 20.7%), malnutrition (9.2 vs 2.1%), undergo chemotherapy (5.2 vs 1.9%). Readmission was associated with higher in-hospital mortality (1.5 vs. 0.1%), CVA (0.6 vs 0.3%), AKI (29.6 vs 16.9%) and pleural effusion (7.8 vs 1.8%). They were also more likely to require mechanical ventilation (3.5 vs 1.8%), parenteral nutrition (1.2 vs 0.4%) and hemodialysis (11.9 vs 4.5%). The in-hospital economic burden of readmission was $128 million in total charges and $31.8 million in total costs. Independent predictors of readmission were disposition to a short-term hospital or skilled nursing facility, length of stay, need for mechanical ventilation and transfusion of blood products, having type 1 diabetes, malnutrition, pleural effusion, and CKD. Younger age and private insurance were associated with preventing readmission. Conclusions: Readmissions after nephrectomy in patients with RCC are associated with increased in-hospital mortality rate and pose a high health care economic burden. We identified few risk factors and patient characteristics associated with post-surgical readmissions; however, further in-depth studies are needed to find preventable risk factors.[Table: see text]
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Gusev, E. Yu, N. V. Zotova, Yu A. Zhuravleva, and V. A. Chereshnev. "Physiological and pathogenic role of scavenger receptors in humans." Medical Immunology (Russia) 22, no. 1 (January 31, 2020): 7–48. http://dx.doi.org/10.15789/1563-0625-pap-1893.

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The scavenger receptors (SRs)) include > 30 different molecules structurally classified into 11 classes (A to L). They are expressed mostly on stromal macrophages, and their expression may be augmented in direct dependence with concentrations of their ligands. The SRs are heterogenous by their structure, however, being common in their functional potential. E.g., different SR classes may participate in absorption of modified low-density lipoproteins and glycated proteins, apoptotic and ageing cells, altered erythrocytes and platelets, like as a big variety of other endogenous ligands from metabolic and cellular “trash”. A common property of SRs is their participation in removal of small pathogen amounts from blood circulation, regulation of cell and tissue stress responses, ability to form complicated receptor complexes with other receptor types including integrins and toll-like receptors. Opposite to classic pattern-recognizing receptors, the SR involvement does not always elicit a pronounced cellular activation and development of pro-inflammatory cellular stress. The SR functional effects provide interactions between different physiological events and immune system, including the processes of neuroendocrine and metabolic regulation. These mechanisms provide both homeostatic stability and, likewise, act at the border of normal and pathological conditions, i.e., participating in pathogenesis of transitional processes, e.g., physiological ageing. Moreover, the SR-associated processes represent a key pathogenetic factor in different somatic diseases, e.g., those associated with low-intensity chronic inflammation, including obesity, type 2 diabetes, atherosclerosis, arterial hypertension, various neurodegenerative disorders. Similarly, the SRs are involved into the processes of cancer transformation and antitumor response, different processes of classical inflammation, from antigen presentation to the morphofunctional T cell and macrophage polarization in the inflammation foci and immunocompetent organs. SR are playing a controversial role in development of acute systemic inflammation, the main reason for lethal outcomes in the intensive care wards. Targeted effects upon the SRs represent a promising approach when treating a broad variety of diseases, whereas detection of membrane-bound and soluble SR forms could be performed by means of diagnostic and monitoring techniques in many human disorders.
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Boytsov, S. A., N. V. Pogosova, F. N. Paleev, M. V. Ezhov, A. L. Komarov, D. V. Pevsner, K. A. Gruzdev, et al. "Clinical Characteristics and Factors Associated with Poor Outcomes in Hospitalized Patients with Novel Coronavirus Infection COVID-19." Kardiologiia 61, no. 2 (February 28, 2021): 4–14. http://dx.doi.org/10.18087/cardio.2021.2.n1532.

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Aim To evaluate the clinical picture and factors associated with unfavorable outcomes in admitted patients with COVID-19.Material and methods This study included all patients admitted to the COVID Center of the National Research Center of Cardiology of the Russian Ministry of Health Care from May 1 through May 31, 2020. Clinical demographic, laboratory, and instrumental indexes and associated factors were studied with one-way and multivariate logistic regression analysis.Results This study included 402 patients aged 18 to 95 years (mean age, 62.9±14.6 years); 43.0 % of them were older than 65 years. COVID-19 was frequently associated with chronic comorbidities, including arterial hypertension (74.4 %), obesity (41.6 %), history of ischemic heart disease (12.9 %), atrial fibrillation (18.9 %), type 2 diabetes mellitus (DM) (13.0 %), and oncological diseases (9.2 %). 13.0 % of patients were smokers; less than 10% had chronic lung diseases. 3.9% of patients had a combination of COVID-19 and acute coronary pathology, including acute myocardial infarction (MI) in 3.2 % (13) and unstable angina in 0.7 % (3). The most frequent clinical manifestation of COVID-19 were four symptoms: cough (81.1 %), weakness (80.3 %), shortness of breath (71.6 %), and fever (62.7 %). 46.5% of patients had shortage of breath and chest pain/compression, 40.3% had headache, 31.1% had myalgia, 28.8% had anosmia, and 25.5% had ageusia. Arterial oxygen saturation was <93.0 % in 55.7 % of cases. According to laboratory blood tests the patients had anemia (58.2 %), lymphopenia (34.8 %), neutropenia (19.2 %), thrombocytopenia (11.9 %), and increased levels of high-sensitivity C-reactive protein (hsCRP, 87.3 %), interleukin-6 (89.3 %), ferritin (62.1 %), and D-dimer (49.2 %). 56.2% of patients required various regimens of oxygen support. 83 (20.6%) patients were admitted to intensive care and resuscitation units; invasive artificial ventilation was performed only for 34 (8.5 %) patients. In-hospital mortality was 7.7 % (31 / 402). One-way regression analysis identified major factors associated with death during the stay in the hospital: age >55 years, NEWS scale score >4.0, oxygen saturation <92.0 %, blood glucose >5.4 mmol/l, hs-CRP >25.7 mg/l, and creatinine clearance <72.0 ml/min. Furthermore, the risk increased with increasing degree of changes in each factor. According to results of the multivariate regression analysis, three most significant predictors of the hard endpoint, all-cause death during the stay in the hospital, were more than 5-fold increases in aspartate aminotransferase and/or alanine aminotransferase compared to normal levels (relative risk (RR) 16.8 at 95 % confidence interval (CI) 5.0–56.3, р<0.001), pronounced changes in the lungs consistent with a CT-4 picture as shown by computed tomography (CT) (RR 13.4; 95 % CI 3.9–45.5, р<0.001), and MI/unstable angina during the stay in the hospital (RR 11.3; 95 % CI 1.4–90.6, р=0.023). The probability of death was also considerably increased by chronic obstructive pulmonary disease, impaired kidney function (creatinine clearance estimated by Cockcroft-Gault <60.0 ml/min), type 2 DM, oncological diseases, and dementia.Conclusion This study established factors associated with unfavorable outcomes in admitted patients with COVID-19. This will allow identifying in advance patients with a high risk of complications that require increased attention to take more active diagnostic and therapeutic measures at prehospital and hospital stages.
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Winter, R., A. Fazlinezhad, S. Martins Fernandes, M. Pellegrino, X. Iriart, S. Moustafa, D. Stolfo, et al. "Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography." European Heart Journal – Cardiovascular Imaging 16, suppl 2 (December 2015): S102—S129. http://dx.doi.org/10.1093/ehjci/jev277.

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19

Leites de Souza Steffen, P., D. Demétrio Faustino da Silva, C. Schilling Mendonça, and E. Meyer. "Motivational Interviewing for the control of type 2 diabetes mellitus and arterial hypertension." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.1084.

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Abstract Background Motivational Interviewing (MI) has been effective in promoting positive changes in various health-related behaviors, including chronic disease management. The main goal of this study was evaluating the effectiveness of this care technology in individual nursing consultations for the control of type 2 Diabetes Mellitus (2DM) and Arterial Hypertension (AH) in primary healthcare. Methods Double-blind, controlled, parallel randomized clinical trial conducted in Porto Alegre, Rio Grande do Sul - Brazil, from June 2018 to July 2019. The study subjects suffered from 2DM with associated diagnosis of AH and were randomized individually to the Test/MI Group and Control Group. The Test Group was subjected to an MI-based nursing consultation intervention with a professional who had been trained for 20 hours, while the Control Group received conventional nursing consultation. The variables were collected in order to measure the main glycated hemoglobin and blood pressure outcomes, and for the secondary adherence outcome. Results After an average follow-up of 6 months, 175 patients completed the study. There was a significant difference between the groups with improvement in the Test/MI group for the outcomes Systolic Blood Pressure - SBP (p &lt; 0.01), Diastolic Blood Pressure - DBP (p &lt; 0.01), Total Adherence Score in Martín-Bayarre-Grau Questionnaire (p = 0.011) and their dimensions 'Treatment compliance' and 'Personal implication' (p = 0.033; p = 0.031). The blood pressure levels of the patients who received the Motivational Interviewing Intervention showed a significant mean reduction of 15.2 mmHg in SBP and 6.4 mmHg in DBP, compared to the control group. The Test group also showed a significant average intragroup reduction of 0.5% in HbA1c at the completion of the study (p &lt; 0.01). Conclusions It is concluded that the MI-based nursing consultation was effective in improving clinical control and adherence in diabetic and hypertensive patients in primary healthcare. Key messages MI-based nursing consultation is effective in reducing pressure and glycemic levels in primary healthcare. The MI improves adherence levels in diabetic and hypertensive patients.
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Alimov, A., F. Khaidarova, S. Ismailov, G. Rakhimova, D. Nazhmutdinova, B. Shagazatova, Ya Pakhomov, A. Alieva, and V. Tsareva. "COST-EFFECTIVE MODEL OF SCREENING FOR TYPE 2 DIABETES IN THE REPUBLIC OF UZBEKISTAN." Bulletin of Emergency Medicine 14, no. 3 (September 20, 2021). http://dx.doi.org/10.54185/tbem/vol14_iss3/a2.

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Epidemiological studies revealed up to 5-6 undiagnosed cases of type 2 diabetes mellitus (DM2) per 1 registered patient. The late diagnosis of DM2 presents a medical and socio-economic problem. Aim. To identify the most cost-effective, easy-to-use method for regular screening for DM2 in primary care settings in the Republic of Uzbekistan. Material and methods. 4 diabetes screening scenarios differing in the inclusion criteria (age 45 vs age 45 plus arterial hypertension plus obesity), and screening methods (testing for glycemia and/or HbA1c) were studied in urban and rural primary care polyclinics among 2430 people. Results. In primary health care real clinical practice, the most cost-effective and easy-to-follow strategy for active screening for DM2 is testing for random glycemia using a certified glucometer, in any resident aged 45 or older visiting his/her GP for any reason. If test results are intermediate, the person is called again the next day for fasting glycemia testing to confirm the diagnosis. If the test results are normal, the person is given recommendations of healthy lifestyle and re-testing in 1 year. If the test result corresponds to DM, the person is referred to a local endocrinologist.
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A.S., Sycheva, Kebina A.L., and Vertkin А.L. "CLINICAL AND PROGNOSTIC CRITERIA FOR THE COMPLICATED COURSE OF NEW CORONAVIRUS INFECTION (COVID-19)." "Medical & pharmaceutical journal "Pulse", September 11, 2021, 147–53. http://dx.doi.org/10.26787/nydha-2686-6838-2021-23-9-147-153.

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Relevance. The pandemic of new coronavirus infection COVID-19 is the main topic and problem of modern medicine associated with the necessity of rapid diagnostics and medical care rendered to such patients Nowadays, individual pathogenetic mechanisms of infection COVID-19 are determined, however, clinical and epidemiological particularities of the disease are being intensively investigated, and new agents for prevention and treatment of infection COVID-19 are being developed. The determination of predictors of the severe disease course and exposure methods is definitely important. The studies have shown that the presence of various concurrent comorbid diseases in patients hospitalized with COVID-19 negatively affects the disease course and its prognosis. Study objective: the analysis of the observation results and clinical outcomes of clinical course (clinical masks) of new coronavirus infection COVID-19 with the distribution by age, gender and incidence of somatic diseases, identification of the pattern of visceral organ damages in coronavirus infection caused by virus SARS-CoV-2. Materials and methods: 110 patients with virus pneumonia caused by COVID-19 were enrolled to the study. The presence of risk factors of the severe disease course variants and intensity of the somatic disorder in necropsy of patients died were evaluated. Study results: The found analysis data suggest that the most significant predictors of the severe course of COVID-19 are arterial hypertension with a high and very high cardiovascular risk, followed by a renal disorder, type 2 diabetes mellitus, obesity, hepatic and heart failure. Conclusion. The found analysis data suggest that the most significant predictors of the severe course of COVID-19 are arterial hypertension with a high and very high cardiovascular risk, followed by a renal disorder, type 2 diabetes mellitus, obesity, hepatic and heart failure.
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Espinosa, Mariano Martínez, Vitesinha Rosa dos Santos Almeida, and Vagner Ferreira Do Nascimento. "Poor glycemic control and associated factors in diabetic people attending a reference outpatient clinic in Mato Grosso, Brazil." Investigación y Educación en Enfermería 39, no. 3 (October 29, 2021). http://dx.doi.org/10.17533/udea.iee.v39n3e10.

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Objective. To identify the proportion of poor of glycemic control and associated factors among people with type 2 diabetes attending a regional reference outpatient clinic in Mato Grosso (Brazil). Methods. This is a cross-sectional quantitative study based on data from medical records of 338 people with type 2 diabetes who attend a state reference outpatient clinic in Mato Grosso (Brazil). Information on glycemic control, sociodemographic factors, lifestyle and clinical conditions was collected. Results. The prevalence of elevated glycated hemoglobin was 47.34%. In the Poisson multiple regression model analysis with robust variance, poor glycemic control was significantly associated (p<0.05) with the following factors: insulin use (Prevalence Ratio -PR = 2.03), fasting glucose ≤70 and ≥100 mg/dL (PR = 2.0), postprandial glucose ≥180 mg/dL (PR = 1.76), no physical activity (PR = 1.62), the interaction between age group ≤59 years and the time of disease diagnosis >10 years (PR = 1.58), and presence of arterial hypertension (PR = 0.79). Conclusion. Most users of the reference outpatient clinic with type 2 diabetes had poor glycemic control associated with risk factors that alter glycated hemoglobin and negatively affect the achievement of established glycemic levels.
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Leonova, I., V. Feoktistova, S. Boldueva, and D. Evdokimov. "Using of optical coherent tomography in the determination of the causes of non-obstructive coronary artery myocardial infarction." European Heart Journal. Acute Cardiovascular Care 10, Supplement_1 (April 1, 2021). http://dx.doi.org/10.1093/ehjacc/zuab020.100.

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Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process. The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non ST elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of hypertonic crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatosis, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, disaggregants were prescribed, patients with spontaneous dissection of CA had recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.
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Zulkifly, H., F. Mansor, I. Abdul Halim Zaki, K. S. Eng, L. C. Kiok, T. Ravi, M. Pathmanathan, S. Abd Wahab, and R. Muda. "Thromboembolic complication among COVID-19 patients in the intensive care unit (ICU): a single-centre study from a Malaysian perspective." European Heart Journal 43, Supplement_1 (February 1, 2022). http://dx.doi.org/10.1093/eurheartj/ehab849.181.

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Abstract Funding Acknowledgements Type of funding sources: None. Introduction The emerging complications of thromboembolism (TE) in COVID-19 patients have led to severe consequence such as death. Nonetheless, the prevalence of TE complications among COVID-19 patients in the Intensive Care Unit (ICU) in Malaysia is unknown. Objective To investigate the prevalence of thromboembolic (TE) complications including venous [deep vein thrombosis (DVT), pulmonary embolism (PE), and line related thrombosis] and arterial [stroke, peripheral arterial disease and myocardial infarction (MI)] thrombosis and mortality among COVID-19 patients admitted to an ICU at a single centre hospital. The proportions of patients with TE complication who died, and factors associated with the occurrence of thrombotic complications were explored. Methods In this retrospective Malaysian cohort study, patients admitted to a single centre ICU with PCR confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included. Thromboembolic (TE) event is a combination of venous and arterial thrombosis. Results Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 4 (0.7%) developed DVT, 198 (37.1%) PE and 2 (0.4%) line related thrombosis. Meanwhile, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, 240 (44.9%) developed TE event during their ICU admission. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p &lt; 0.001) and MI (16.4% vs. 4.6%; p &lt; 0.001) died. Age, duration of ICU admission, obesity, white cell count (WCC), troponin, D-Dimer and corticosteroid use were significantly greater among those with TE events. Demographics, co-morbidities, other laboratory parameters and inflammatory markers were similar in COVID-19 patients with and without TE events. Predictors of TE events on multivariate logistic regression analysis were age [OR 1.02 (95% CI 1.00-1.03)], obesity [OR 2.84 (95% CI 1.93-4.18)], WCC [OR 1.04 (95% CI 1.00-1.07)], and duration of ICU admission [OR 1.04 (95% CI 1.02-1.06)]. Conclusion In this cohort of severely ill COVID-19 patients, the overall prevalence of TE complication was high (44.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of TE events included age, obesity, white cell count, and duration of ICU admission. Perhaps a more aggressive treatment (combination of thromboprophylaxis and enhanced anti-inflammatory treatment) may be needed among COVID-19 patients admitted to ICU with high risk factors to prevent further increase in the incidence of thromboembolism and death.
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Henein, M. Y., I. Bytyci, R. Nicoll, R. Sheneuda, S. Ayad, M. Cameli, and F. Vancheri. "Combined cardiac risk factors predict COVID-19 related mortality and the need for mechanical ventilation in Coptic Clergy." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2456.

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Abstract Background and aims The clinical adverse events of COVID-19 among clergy worldwide have been found higher than among ordinary communities, probably because of the nature of their work. The aim of this study, was to assess the impact of cardiac risk factors on COVID-19-related mortality and the need for mechanical ventilation in Coptic clergy. Methods Of 1576 Coptic clergy participating in the COVID-19-Clergy study, serving in Egypt, USA and Europe, 213 had the infection and were included in this analysis. Based on the presence of systemic arterial hypertension (AH), participants were divided into two groups: Group-I, Clergy with AH (n=77) and Group-II, without AH (n=136).Participants' demographic indices, cardiovascular risk factors, COVID-19 management details and related mortality were assessed. Results Clergy with AH were older (p&lt;0.001), more obese (p=0.04), had frequent type 2 diabetes (DM) (p=0.001), dyslipidemia (p=0.001) and coronary heart disease (CHD) (p=0.04) compared to those without AH. COVID-19 treatment at home, hospital or in intensive care did not differ between the patient groups (p&gt;0.05 for all). Clergy serving in Northern and Southern Egypt had a higher mortality rate compared to those from Europe and the USA combined (5.22%, 6.38%, 0%; p=0.001). The impact of AH on mortality was significant only in Southern Egypt (10% vs. 3.7%; p=0.01) but not in Northern Egypt (4.88% vs. 5.81%; p=0.43). In multivariate analysis, CHD OR 1.607 [(0.982 to 3.051); p=0.02] and obesity, OR 3.403 [(1.902 to 4.694); p=0.04]predicted COVID-19 related mortality. A model combining cardiac risk factors (systolic blood pressure (SBP) ≥160 mmHg, DM, obesity, dyslipidemia and history of CHD), was the most powerful independent predictor of COVID-19-related mortality, OR 4.813 [(2.011 to 7.017); p=0.008]. The same model also proved the best independent multivariate predictor of mechanical ventilation OR 1.444 [(0.949 to 11.88); p=0.001]. Conclusion In Coptic clergy, the cumulative impact of risk factors is the most powerful predictor of mortality and the need for mechanical ventilation in Coptic clergy. Funding Acknowledgement Type of funding sources: None.
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Kirkpatrick, Angelia C., Julie A. Stoner, Fabiola M. Donna-Ferreira, George C. Malatinszky, Adreinne M. Elias, Leslie D. Guthery, Daniel A. Garcia-Martino, Eka Makharoblidze, and Calin I. Prodan. "Abstract TP436: Native American Veterans With Vascular Risk Factors Have High Rates of Vascular Cognitive Impairment." Stroke 48, suppl_1 (February 2017). http://dx.doi.org/10.1161/str.48.suppl_1.tp436.

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Background: Rates of cardiovascular disease and stroke are elevated in Native Americans, and a greater propensity to develop vascular cognitive impairment (VCI) rather than Alzheimer-type dementia has been inferred, supporting a need for further research in VCI in this population. We determined rates and patterns of memory loss among Native American veterans with multiple vascular risk factors. Methods: Native American veterans ≥50 years old with ≥2 vascular risk factors, including smoking history, hyperlipidemia, diabetes, coronary artery disease, or peripheral arterial disease, were recruited between September 2015 and May 2016. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores <26 were referred for imaging studies, memory loss serology, neuropsychiatric testing and clinical assessment by a memory loss physician. Final cognitive status was assigned by blinded adjudication. Results: We recruited 60 Native Americans aged 50-86 (mean±SD: 64±7.1 years); 90% were male, 95% had at least high-school education, and 69% had some college or advanced degrees. Risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and prior/current smoking (78%). Eight (13%) with severe depression were excluded, leaving 23/51 with abnormal MoCA scores (44%, 95%CI 30%-59%). All with cognitive impairment were male compared to 83% among non-impaired subjects (p=0.059). Fifteen completed additional evaluation for memory loss, including 4/15 with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), or as having non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). MoCA correctly identified cognitive status in 86% (Kappa 0.66, 95%CI 0.23-1.00). Conclusions: Native American veterans have high rates of vascular cognitive impairment, which exceed rates of cognitive impairment documented in previously published older non-Native American cohorts. These results highlight the need for improved vascular risk reduction among Native American veterans. Further study is needed to identify ways to improve care in this underserved and understudied population.
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Antillon, Daphne, Natalie Valle, Kaiwen Lin, Waimei Tai, Mary Ann Gallup, Bruce Ovbiagele, and Amytis Towfighi. "Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a3358.

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Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.
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