Pub Date : 2020-09-18DOI: 10.31487/j.jicoa.2020.05.06
V. Serhiyenko, S. Ajmi, A. Serhiyenko
Background: Treatment of diabetic cardiac autonomic neuropathy (CAN) is a complex process, that includes: lifestyle modification; reducing of insulin resistance (IR); optimal glycemic control; management of diabetic dyslipidemia; antioxidants; vitamins; treatment of myocardial metabolic abnormalities; thrombosis and others. The aim of study was to investigate the effects of simvastatin on insulin resistance and blood lipid profile parameters in patients with type 2 diabetes mellitus (DM) and the definite stage of cardiac autonomic neuropathy. Methods: The study involved 107 patients with type 2 DM among them 16 patients without CAN, 19 with subclinical stage of CAN and 72 with definite CAN. Median age of patients was 53.6±0.41 years, disease duration - 4.12±0.24 years and median glycated hemoglobin (HbA1c) - 7.01%±0.09%. The control group included 14 almost healthy people without DM. Patients with definite CAN were allocated into two treatment groups: 1st group - 22 patients received standard hypoglycemic therapy and simvastatin 20 mg/day; 2nd group - control (n = 15). The duration of the study was 3 mos. The concentrations of glucose, HbA1c, immunoreactive insulin (IRI) in the blood were determined. Lipid metabolism was assessed by the concentration of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) measurements. The IR index (HOMA-IR), atherogenic coefficient (AC), TG/HDL-C parameters, and TG-glucose (TyG) index were calculated. Result: It was established that in patients with type 2 DM with subclinical stage of CAN there was statistically significant increase in the parameters of HbA1c, IRI, TC, TG and HOMA-IR, AC, TyG indices and decrease of TG/HDL-C and HDL-C compared to control; increase of IRI, TG, TG/HDL-C and TyG indices compared to patients with type 2 DM without CAN. The definite stage of CAN is characterized by an increase of HbA1c, IRI, TC, LDL-C levels and HOMA-IR, AC indices and a significant decrease in the concentration of HDL-C (compared to patients with subclinical CAN). As a result of our study, we found out that prescription of simvastatin to patients with definite stage of CAN was accompanied by a statistically significant decrease in the concentration of TC, LDL-C, TG and an increase in the content of HDL-C (compared to 2nd, control group). Conclusion: Obtained results justify the appropriateness of statins prescription to patients with type 2 DM and the definite stage of CAN.
{"title":"Diabetic Cardiovascular Autonomic Neuropathy: Insulin Resistance, Lipids and Simvastatin","authors":"V. Serhiyenko, S. Ajmi, A. Serhiyenko","doi":"10.31487/j.jicoa.2020.05.06","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.05.06","url":null,"abstract":"Background: Treatment of diabetic cardiac autonomic neuropathy (CAN) is a complex process, that\u0000includes: lifestyle modification; reducing of insulin resistance (IR); optimal glycemic control; management\u0000of diabetic dyslipidemia; antioxidants; vitamins; treatment of myocardial metabolic abnormalities;\u0000thrombosis and others. The aim of study was to investigate the effects of simvastatin on insulin resistance\u0000and blood lipid profile parameters in patients with type 2 diabetes mellitus (DM) and the definite stage of\u0000cardiac autonomic neuropathy.\u0000Methods: The study involved 107 patients with type 2 DM among them 16 patients without CAN, 19 with\u0000subclinical stage of CAN and 72 with definite CAN. Median age of patients was 53.6±0.41 years, disease\u0000duration - 4.12±0.24 years and median glycated hemoglobin (HbA1c) - 7.01%±0.09%. The control group\u0000included 14 almost healthy people without DM. Patients with definite CAN were allocated into two\u0000treatment groups: 1st group - 22 patients received standard hypoglycemic therapy and simvastatin 20\u0000mg/day; 2nd group - control (n = 15). The duration of the study was 3 mos. The concentrations of glucose,\u0000HbA1c, immunoreactive insulin (IRI) in the blood were determined. Lipid metabolism was assessed by the\u0000concentration of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density\u0000lipoprotein cholesterol (HDL-C), triglycerides (TG) measurements. The IR index (HOMA-IR), atherogenic\u0000coefficient (AC), TG/HDL-C parameters, and TG-glucose (TyG) index were calculated.\u0000Result: It was established that in patients with type 2 DM with subclinical stage of CAN there was\u0000statistically significant increase in the parameters of HbA1c, IRI, TC, TG and HOMA-IR, AC, TyG indices\u0000and decrease of TG/HDL-C and HDL-C compared to control; increase of IRI, TG, TG/HDL-C and TyG\u0000indices compared to patients with type 2 DM without CAN. The definite stage of CAN is characterized by\u0000an increase of HbA1c, IRI, TC, LDL-C levels and HOMA-IR, AC indices and a significant decrease in the\u0000concentration of HDL-C (compared to patients with subclinical CAN). As a result of our study, we found\u0000out that prescription of simvastatin to patients with definite stage of CAN was accompanied by a statistically\u0000significant decrease in the concentration of TC, LDL-C, TG and an increase in the content of HDL-C\u0000(compared to 2nd, control group).\u0000Conclusion: Obtained results justify the appropriateness of statins prescription to patients with type\u00002 DM and the definite stage of CAN.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44495711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Bleeding is a major concern after cardiac surgery and also a significant cause of morbidity and mortality. Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: To find out Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients. Methods: This comparative cross-sectional study was carried out at the Department of Cardiac Surgery in BSMMU hospital from March, 2017 to August, 2019. The study population was 60, with 2 (two) groups having 30 patients in each. Patients from both the groups underwent OPCAB. Statistical analysis of different characteristics between the patients of both groups was done to draw a conclusion. Results: This study total sixty (60) patients who underwent off-pump coronary artery bypass graft surgery were evaluated in this study. Postoperative care at ICU was given to the patients of both groups as per standard hospital protocol. The findings of the study obtained from data analysis presented in the following pages. Among the study population mean age in group A was 55.43±8.53 years and in group B was 59.63±6.86 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were statistically not significant (p>0.05). Shows the comparison of postoperative variables between group A and B patients. Amount blood loss in 1st 12 hours immediate after surgery in group A and B were 185.67±35.20 ml and 219.67±57.32 ml respectively. Post-operative blood transfusion in group A and B were 2±0.53 units and 2.5±0.68 units respectively, which was statistically significant (p<0.05. There were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. The most valuable predictor for increased postoperative bleeding after OPCAB. Conclusion: In conclusion the efficacy were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. Pearson co-efficient correlation test showed an inverse relationship between plasma fibrinogen level and postoperative bleeding following OPCAB. Fibrinogen concentration level was associated with increased postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting surgical patients.
{"title":"Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients","authors":"","doi":"10.33140/coa.05.03.01","DOIUrl":"https://doi.org/10.33140/coa.05.03.01","url":null,"abstract":"Background: Bleeding is a major concern after cardiac surgery and also a significant cause of morbidity and mortality. Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: To find out Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients. Methods: This comparative cross-sectional study was carried out at the Department of Cardiac Surgery in BSMMU hospital from March, 2017 to August, 2019. The study population was 60, with 2 (two) groups having 30 patients in each. Patients from both the groups underwent OPCAB. Statistical analysis of different characteristics between the patients of both groups was done to draw a conclusion. Results: This study total sixty (60) patients who underwent off-pump coronary artery bypass graft surgery were evaluated in this study. Postoperative care at ICU was given to the patients of both groups as per standard hospital protocol. The findings of the study obtained from data analysis presented in the following pages. Among the study population mean age in group A was 55.43±8.53 years and in group B was 59.63±6.86 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were statistically not significant (p>0.05). Shows the comparison of postoperative variables between group A and B patients. Amount blood loss in 1st 12 hours immediate after surgery in group A and B were 185.67±35.20 ml and 219.67±57.32 ml respectively. Post-operative blood transfusion in group A and B were 2±0.53 units and 2.5±0.68 units respectively, which was statistically significant (p<0.05. There were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. The most valuable predictor for increased postoperative bleeding after OPCAB. Conclusion: In conclusion the efficacy were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. Pearson co-efficient correlation test showed an inverse relationship between plasma fibrinogen level and postoperative bleeding following OPCAB. Fibrinogen concentration level was associated with increased postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting surgical patients.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87138434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertension hasbeen recognized as aglobalhealth concern fordeveloping countries.Secondary hypertension(SH)including endocrine hypertension has been reported to be uncommon and is scarcely described in many of these countries. There is no current nationally representative study. Therefore, we estimated the prevalence of SH among hypertensive patients in private clinic by screening. The goal of the cross-sectional study conducted from May 2017to June2018 was to estimate the prevalence of hypertension inPakistani population based on data collected fromthe screening held at private clinic inKarachi. From the initial screening of 566 patients, we suspected 437 (M:187), (F:250) patients to have secondary hypertension and conducted tests for the cause of hypertension, measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration an dpasmacatechol amine concentration. Asasecondary screening, were ferred patients for furosemide plus upright test, captopril renography, dexamethasone suppression test, abdominal ultrasonography (US), abdominal CT. and arteriography investigations. These tests clearly demonstrated that the prevalence of Secondary Hypertension was 8.1% among 437 patients investigated. 42 were found to have Renal parenchymal disease; 25 were having Acute Renal Failure; 15 patients had Calculi; 29 patients had chronic glomerulonephritis leading to CRF and 3 had reno vascular hypertension. Further, 2 cases with aortic coarctation were found on arteriography; 1 patient had primary aldosteronism; 5 had primary hyperparathyroidism; 6 patients had hyperthyroidism and 11 had Hypothyroidism. In seven cases of hydronephrosis (two known and five newly detected) we could not determine whether the hypertension was caused by the hydronephrosis. The prevalence of curable SH among hypertensive subjects was higher in this screening study, conducted in majority of cases with simple tests. The rates of blood pressure screening in Pakistan are worryingly low; the underlying disease in hypertensive patients should be treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complication. This calls for the establishment of a nationwide program on screening to improve detection, awareness and treatment of hypertension.
{"title":"Screening of Secondary Hypertension in Private Clinic in Karachi, Pakistan: A Randomised Study","authors":"","doi":"10.33140/coa.05.03.02","DOIUrl":"https://doi.org/10.33140/coa.05.03.02","url":null,"abstract":"Hypertension hasbeen recognized as aglobalhealth concern fordeveloping countries.Secondary hypertension(SH)including endocrine hypertension has been reported to be uncommon and is scarcely described in many of these countries. There is no current nationally representative study. Therefore, we estimated the prevalence of SH among hypertensive patients in private clinic by screening. The goal of the cross-sectional study conducted from May 2017to June2018 was to estimate the prevalence of hypertension inPakistani population based on data collected fromthe screening held at private clinic inKarachi. From the initial screening of 566 patients, we suspected 437 (M:187), (F:250) patients to have secondary hypertension and conducted tests for the cause of hypertension, measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration an dpasmacatechol amine concentration. Asasecondary screening, were ferred patients for furosemide plus upright test, captopril renography, dexamethasone suppression test, abdominal ultrasonography (US), abdominal CT. and arteriography investigations. These tests clearly demonstrated that the prevalence of Secondary Hypertension was 8.1% among 437 patients investigated. 42 were found to have Renal parenchymal disease; 25 were having Acute Renal Failure; 15 patients had Calculi; 29 patients had chronic glomerulonephritis leading to CRF and 3 had reno vascular hypertension. Further, 2 cases with aortic coarctation were found on arteriography; 1 patient had primary aldosteronism; 5 had primary hyperparathyroidism; 6 patients had hyperthyroidism and 11 had Hypothyroidism. In seven cases of hydronephrosis (two known and five newly detected) we could not determine whether the hypertension was caused by the hydronephrosis. The prevalence of curable SH among hypertensive subjects was higher in this screening study, conducted in majority of cases with simple tests. The rates of blood pressure screening in Pakistan are worryingly low; the underlying disease in hypertensive patients should be treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complication. This calls for the establishment of a nationwide program on screening to improve detection, awareness and treatment of hypertension.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89778746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-14DOI: 10.31487/J.JICOA.2020.04.15
M. Yakhchali, M. M. Ardakani, M. A. Vaghasloo, M. Vazirian, S. Sadrai
Background: Sekanjabin-e buzuri consisting extracts of Chicorium intybus L. (Kasni), Cuscuta chinensis Lam. (Koshus), Apium graveolens L. (Karafs) and Pimpinella anisum L. (Anison) seeds is a Traditional Persian Medicine product. These drugs have many applications in traditional medicine, but they are more effective in opening vascular obstructions and related functions, especially in cardiovascular system. Purpose: In this study we prepared a proper Sekanjabin-e buzuri and developed a HPLC method for analysis of chlorogenic acid (CGA), as an herbal marker compound, for quality control and standardization in both Sekanjabin-e buzuri syrup and its ingredient sources. Methods: Sekanjabin-e buzuri is a group of oxymels that have many different formulations. A proper formulation has chosen from literature (from Gharabadin-e-salehi) and prepared. For standardization of Sekanjabin-e buzuri we developed a method for detecting chlorogenic acid content. A reversed phase MZ C18 column (150*3.0 mm, 5µm) using a mixture of acetonitrile-phosphoric acid 0.1% with gradient elution program for 20 minutes with flow rate of 1.5 ml/min with UV detection at 330 nm. Results: The chlorogenic acid Rt =5.1 minutes and linear over the range of 0.2-1.5 µg/ml, (R2 = 0.9996). The calculated LOD and LOQ of chlorogenic acid were 0.02 and 0.06 µg/ml, respectively. The concentration of chlorogenic acid was 7.69, 10.37, 2.25, 2.88 and 22.86 µg/ml for Chicorium intybus L., Cuscuta chinensis Lam., Apium graveolens L. and Pimpinella anisum L. seeds and Sekanjabin-e buzuri syrup, respectively. Conclusion: This standardized Sekanjabin-e buzuri syrup will be used as a vascular opener (Mofatteh) complementary product for opening internal organs obstruction e.g. promoting cardiovascular health.
{"title":"Preparation of Oxymel (Sekanjabin-e) Buzuri Syrup as Vascular Opener (Mofatteh) Product and Its Standardization","authors":"M. Yakhchali, M. M. Ardakani, M. A. Vaghasloo, M. Vazirian, S. Sadrai","doi":"10.31487/J.JICOA.2020.04.15","DOIUrl":"https://doi.org/10.31487/J.JICOA.2020.04.15","url":null,"abstract":"Background: Sekanjabin-e buzuri consisting extracts of Chicorium intybus L. (Kasni), Cuscuta chinensis\u0000Lam. (Koshus), Apium graveolens L. (Karafs) and Pimpinella anisum L. (Anison) seeds is a Traditional\u0000Persian Medicine product. These drugs have many applications in traditional medicine, but they are more\u0000effective in opening vascular obstructions and related functions, especially in cardiovascular system.\u0000Purpose: In this study we prepared a proper Sekanjabin-e buzuri and developed a HPLC method for analysis\u0000of chlorogenic acid (CGA), as an herbal marker compound, for quality control and standardization in both\u0000Sekanjabin-e buzuri syrup and its ingredient sources.\u0000Methods: Sekanjabin-e buzuri is a group of oxymels that have many different formulations. A proper\u0000formulation has chosen from literature (from Gharabadin-e-salehi) and prepared. For standardization of\u0000Sekanjabin-e buzuri we developed a method for detecting chlorogenic acid content. A reversed phase MZ\u0000C18 column (150*3.0 mm, 5µm) using a mixture of acetonitrile-phosphoric acid 0.1% with gradient elution\u0000program for 20 minutes with flow rate of 1.5 ml/min with UV detection at 330 nm.\u0000Results: The chlorogenic acid Rt =5.1 minutes and linear over the range of 0.2-1.5 µg/ml, (R2 = 0.9996).\u0000The calculated LOD and LOQ of chlorogenic acid were 0.02 and 0.06 µg/ml, respectively. The\u0000concentration of chlorogenic acid was 7.69, 10.37, 2.25, 2.88 and 22.86 µg/ml for Chicorium intybus L.,\u0000Cuscuta chinensis Lam., Apium graveolens L. and Pimpinella anisum L. seeds and Sekanjabin-e buzuri\u0000syrup, respectively.\u0000Conclusion: This standardized Sekanjabin-e buzuri syrup will be used as a vascular opener (Mofatteh)\u0000complementary product for opening internal organs obstruction e.g. promoting cardiovascular health.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42595147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31487/j.jicoa.2020.04.11
A. Abdou, F. Nya, M. Bamous, R. Mounir, N. Atmani, A. Seghrouchni, Y. Moutakiallah, A. Boulahya, M. Aithoussa
Patients with coronary artery disease associated with severe left ventricular dysfunction, candidates for surgical myocardial revascularization, are with high operative risk. The aim of this study was to assess short and long-term morbidity and mortality and to identify their predictive factors. Methods: We conducted a retrospective study in the cardiac surgery department of the Military Instruction Hospital Mohammed V- Rabat, between 2000 and 2015. The statistical analysis was executed by SPSS. There were 74 patients (mean age 74±10 years, ejection fraction [FE]: 30.07%±4 .5, Euroscore: 6.6±2.9). Results: Hospital mortality was 9.5%, with a follow up time of 59.2 ± 36 months. The survival rate at 10 years was 57%. There was also an improvement in their clinical symptoms and echocardiographic parameters (postoperative FE: 40.36%±11.2). Conclusion: In this group of patients with high operative risk, the long-term results of several studies demonstrate the superiority of surgical treatment on medical treatment.
{"title":"Surgical Myocardial Revascularization in Patients with Severe Left Ventricular Dysfunction: Experience in the Cardiac Surgery Department of the Military Hospital Mohammed V of Rabat","authors":"A. Abdou, F. Nya, M. Bamous, R. Mounir, N. Atmani, A. Seghrouchni, Y. Moutakiallah, A. Boulahya, M. Aithoussa","doi":"10.31487/j.jicoa.2020.04.11","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.04.11","url":null,"abstract":"Patients with coronary artery disease associated with severe left ventricular dysfunction, candidates for surgical myocardial revascularization, are with high operative risk. The aim of this study was to assess short and long-term morbidity and mortality and to identify their predictive factors. Methods: We conducted a retrospective study in the cardiac surgery department of the Military Instruction Hospital Mohammed V- Rabat, between 2000 and 2015. The statistical analysis was executed by SPSS. There were 74 patients (mean age 74±10 years, ejection fraction [FE]: 30.07%±4 .5, Euroscore: 6.6±2.9). Results: Hospital mortality was 9.5%, with a follow up time of 59.2 ± 36 months. The survival rate at 10 years was 57%. There was also an improvement in their clinical symptoms and echocardiographic parameters (postoperative FE: 40.36%±11.2). Conclusion: In this group of patients with high operative risk, the long-term results of several studies demonstrate the superiority of surgical treatment on medical treatment.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48541754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-29DOI: 10.31487/j.jicoa.2020.04.19
R. Modi, S. Modi
Current guidelines for acute coronary syndrome are derived from the data in randomized clinical trials and metanalysis conducted in patients. These patients are generally of younger age. The data of acute coronary syndrome in octogenarians is mainly derived from registries. This mid and long-term data regarding medical therapy or interventions in octogenarians is low in number with smaller subsets of patients. Most of the physicians are reluctant to use the same guidelines in these elderly patients due to increased chances of complications. This article reviews the available data and literature in acute coronary syndrome in octogenarians and provides management perspectives for these elderly patients.
{"title":"Acute Coronary Syndrome in Octogenerians: Management Perspectives","authors":"R. Modi, S. Modi","doi":"10.31487/j.jicoa.2020.04.19","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.04.19","url":null,"abstract":"Current guidelines for acute coronary syndrome are derived from the data in randomized clinical trials and\u0000metanalysis conducted in patients. These patients are generally of younger age. The data of acute coronary\u0000syndrome in octogenarians is mainly derived from registries. This mid and long-term data regarding medical\u0000therapy or interventions in octogenarians is low in number with smaller subsets of patients. Most of the\u0000physicians are reluctant to use the same guidelines in these elderly patients due to increased chances of\u0000complications. This article reviews the available data and literature in acute coronary syndrome in\u0000octogenarians and provides management perspectives for these elderly patients.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48480695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-05DOI: 10.21203/rs.3.rs-46163/v1
Qianqian Li, Tingjiao Liu, Shanshan Yang
Background Although intravenous thrombolysis therapy has been considered as a significant progress in the treatment of acute ischemic stroke, there are limited effective treatments for patients with onset ischemic symptom that beyond six hours during acute ischemic stroke. In this study, we investigated the effectiveness of the intravenous argatroban therapy in acute ischemic stroke patients who cannot be treated with intravenous thrombolysis due to the limited time window. Methods One hundred and eighty patients with acute ischemic stroke that had beyond six hours ischemic symptom were admitted to our hospital and were analyzed retrospectively. Levels of activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT) in peripheral blood of these patients were measured by ELISA at 24 hours post initial therapy. Results We found that plasma TT was significantly prolonged after 24 hours of argatroban treatment. aPTT showed slightly increased prolongation after 24 hours of argatroban treatment. PT also showed slightly prolonged after treatment, however, there was no difference from the basal line. We further investigated the relationship between the level of TT and the clinical effectiveness and safety of intravenous argatroban therapy. We found that when TT was between 40 and 80 seconds, intravenous argatroban effectively promoted the complete recovery rates without increasing the risk of hemorrhage. Conclusion Our study implies that TT assay might be useful for guiding regular dose of agratroban for therapy.
{"title":"Using thrombin time to evaluate the efficacy of anticoagulant therapy for acute cerebral infarction","authors":"Qianqian Li, Tingjiao Liu, Shanshan Yang","doi":"10.21203/rs.3.rs-46163/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-46163/v1","url":null,"abstract":"\u0000 Background\u0000\u0000Although intravenous thrombolysis therapy has been considered as a significant progress in the treatment of acute ischemic stroke, there are limited effective treatments for patients with onset ischemic symptom that beyond six hours during acute ischemic stroke. In this study, we investigated the effectiveness of the intravenous argatroban therapy in acute ischemic stroke patients who cannot be treated with intravenous thrombolysis due to the limited time window.\u0000Methods\u0000\u0000One hundred and eighty patients with acute ischemic stroke that had beyond six hours ischemic symptom were admitted to our hospital and were analyzed retrospectively. Levels of activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT) in peripheral blood of these patients were measured by ELISA at 24 hours post initial therapy.\u0000Results\u0000\u0000We found that plasma TT was significantly prolonged after 24 hours of argatroban treatment. aPTT showed slightly increased prolongation after 24 hours of argatroban treatment. PT also showed slightly prolonged after treatment, however, there was no difference from the basal line. We further investigated the relationship between the level of TT and the clinical effectiveness and safety of intravenous argatroban therapy. We found that when TT was between 40 and 80 seconds, intravenous argatroban effectively promoted the complete recovery rates without increasing the risk of hemorrhage.\u0000Conclusion\u0000\u0000Our study implies that TT assay might be useful for guiding regular dose of agratroban for therapy.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90909094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-23DOI: 10.31487/j.jicoa.2020.03.03
Zakarya Ahmed, Xing-wei He, Saddam Shaiea, H. Zeng
Background: Complicated type B aortic dissections require surgery or thoracic endovascular aortic repair (TEVAR). In this study, we sought to explore the early and mid-term clinical efficacy of TEVAR treatment for Stanford complicated type B aortic dissection. Methods: From January 2012 to October 2017, the medical records and the aortic imaging data of 172 consecutive patients treated by TEVAR were retrospectively reviewed for statistical analysis. Aortic remodeling was evaluated based on the preoperative and one-year postoperative followed-up aortic CTA scan results. We analysed the diameters of the total aortic lumens, True and False lumens diameter and the thrombosis status at different five levels along the descending aorta. Results: The primary technical success rate was 97%, and the clinical success rate was 94.8%. At 1-year of aortic CTA follow-up after TEVAR, the true lumen diameter at the stented descending thoracic aorta increased significantly, the false lumen diameter significantly reduced. The remodeling process was stable with mild changes of true lumen increase and false lumen reduction at the unstented distal part of the descending thoracic and the abdominal aorta. Conclusion: This study confirmed that TEVAR treatment for complicated type B aortic dissection has a low mortality rate of mid-term follow-up outcomes. TEVAR stabilizes the size of the aorta and precipitates in FL thrombosis. However, FL in the abdominal aorta still patented and must be carefully observed for further long-term events.
{"title":"Mid-Term Clinical and Morphological Outcomes After Thoracic Endovascular Aortic Repair for Complicated Type B Aortic Dissection","authors":"Zakarya Ahmed, Xing-wei He, Saddam Shaiea, H. Zeng","doi":"10.31487/j.jicoa.2020.03.03","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.03.03","url":null,"abstract":"Background: Complicated type B aortic dissections require surgery or thoracic endovascular aortic repair\u0000(TEVAR). In this study, we sought to explore the early and mid-term clinical efficacy of TEVAR treatment\u0000for Stanford complicated type B aortic dissection.\u0000Methods: From January 2012 to October 2017, the medical records and the aortic imaging data of 172\u0000consecutive patients treated by TEVAR were retrospectively reviewed for statistical analysis. Aortic\u0000remodeling was evaluated based on the preoperative and one-year postoperative followed-up aortic CTA\u0000scan results. We analysed the diameters of the total aortic lumens, True and False lumens diameter and the\u0000thrombosis status at different five levels along the descending aorta.\u0000Results: The primary technical success rate was 97%, and the clinical success rate was 94.8%. At 1-year of\u0000aortic CTA follow-up after TEVAR, the true lumen diameter at the stented descending thoracic aorta\u0000increased significantly, the false lumen diameter significantly reduced. The remodeling process was stable\u0000with mild changes of true lumen increase and false lumen reduction at the unstented distal part of the\u0000descending thoracic and the abdominal aorta.\u0000Conclusion: This study confirmed that TEVAR treatment for complicated type B aortic dissection\u0000has a low mortality rate of mid-term follow-up outcomes. TEVAR stabilizes the size of the aorta and\u0000precipitates in FL thrombosis. However, FL in the abdominal aorta still patented and must be\u0000carefully observed for further long-term events.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48307070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-22DOI: 10.31487/j.jicoa.2020.03.10
A. Contreras, A. Peirone, I. Juaneda
A 20-year-old boy with Down´s syndrome presented to the emergency department with new onset acute heart failure. Right side chest effusion and cardiomegaly was observed on chest x-ray. A mobile aneurysmal sac protruding into the right atrium was detected and a ruptured aneurysm of the right coronary sinus of Valsalva was observed in transthoracic echocardiogram. Cardiac angiography catheterization confirmed the diagnosis. Surgical repair consisting of aneurysm resection and defect closure was performed shortly after with pericardium reinforced suture through the right atrium. The patient was discharged uneventfully.
{"title":"Repair of Ruptured Sinus of Valsalva Aneurysm: Rare Cause of Acute Onset Congestive Heart Failure in Down’s Syndrome","authors":"A. Contreras, A. Peirone, I. Juaneda","doi":"10.31487/j.jicoa.2020.03.10","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.03.10","url":null,"abstract":"A 20-year-old boy with Down´s syndrome presented to the emergency department with new onset acute\u0000heart failure. Right side chest effusion and cardiomegaly was observed on chest x-ray. A mobile aneurysmal\u0000sac protruding into the right atrium was detected and a ruptured aneurysm of the right coronary sinus of\u0000Valsalva was observed in transthoracic echocardiogram. Cardiac angiography catheterization confirmed the\u0000diagnosis. Surgical repair consisting of aneurysm resection and defect closure was performed shortly after\u0000with pericardium reinforced suture through the right atrium. The patient was discharged uneventfully.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45419292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-15DOI: 10.31487/j.jicoa.2020.03.08
A. Barceló, A. Galil, Gabrielle Quirino, Guilherme Gouveia Hollunder, Ramon José Moreira Silva, Valéria Mata de Duarte Ferreira Ribeiro
Aim: The aim of the present study was to assess whether there is an association between smoking and higher mortality and hospitalization due to the disease of the new coronavirus (COVID-19). Methods: A systematic review of studies on the novel coronavirus containing information on smoking and its association with COVID-19 mortality was carried out. The bibliographic search was performed using six databases, with the search terms: ['novel coronavirus' OR ‘COVID- 19'] AND ['smoking' OR ‘tobacco'] AND ['mortality']. Studies published from December 2019 until April 8, 2020 were included. As an inclusion criterion, studies targeting humans, adults, infected with Sars-Cov-2 were selected, and as the chosen language, English. Results: From the total of researched studies, 65 articles were selected, one being presented in two databases simultaneously. As a final result of this review, 11 articles were included, with a population total estimated at 84.050 patients, with the prevalence of smokers ranged from 1.4% to 27.3% and it was observed that the impact of smoking on fatal outcomes was described in four publications, with unfavourable repercussions on hospitalization rates and more serious conditions secondary to COVID-19 (9 out of the 11 publications evaluated). Conclusion: The presence of smoking can worsen infectious conditions by COVID-19 and increase the prevalence of hospitalizations and fatal outcomes, especially in men, the elderly and those with multimorbidities. Smoking status should be used in the screening of patients infected with the novel coronavirus given the evidence of poorer outcomes among smokers.
目的:本研究的目的是评估吸烟与新型冠状病毒(COVID-19)引起的高死亡率和住院率之间是否存在关联。方法:对有关新型冠状病毒吸烟及其与COVID-19死亡率相关性的研究进行系统综述。使用六个数据库进行文献检索，检索词为:['novel coronavirus' OR ' COVID- 19'] AND ['smoking' OR ' tobacco']AND ['mortality']。纳入了2019年12月至2020年4月8日发表的研究。作为纳入标准，选择了以感染Sars-Cov-2的成人为目标的研究，并选择了英语作为选择语言。结果:共筛选到65篇论文，其中1篇在两个数据库中同时发表。本次综述的最终结果是纳入了11篇文章，总人数估计为84.050名患者，吸烟者的患病率从1.4%到27.3%不等，观察到吸烟对致命结局的影响在4篇出版物中被描述，对住院率的不利影响和继发于COVID-19的更严重的情况(11篇出版物中有9篇)。结论:吸烟可使COVID-19感染情况恶化，增加住院率和死亡率，特别是在男性、老年人和多病患者中。鉴于有证据表明吸烟者的预后较差，应将吸烟状况用于筛查感染新型冠状病毒的患者。
{"title":"Smoking is Associated with Higher Mortality and Hospitalization Secondary to Novel Coronavirus: A Systematic Review","authors":"A. Barceló, A. Galil, Gabrielle Quirino, Guilherme Gouveia Hollunder, Ramon José Moreira Silva, Valéria Mata de Duarte Ferreira Ribeiro","doi":"10.31487/j.jicoa.2020.03.08","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.03.08","url":null,"abstract":"Aim: The aim of the present study was to assess whether there is an association between smoking and higher\u0000mortality and hospitalization due to the disease of the new coronavirus (COVID-19).\u0000Methods: A systematic review of studies on the novel coronavirus containing information on smoking and\u0000its association with COVID-19 mortality was carried out. The bibliographic search was performed using six\u0000databases, with the search terms: ['novel coronavirus' OR ‘COVID- 19'] AND ['smoking' OR ‘tobacco']\u0000AND ['mortality']. Studies published from December 2019 until April 8, 2020 were included. As an\u0000inclusion criterion, studies targeting humans, adults, infected with Sars-Cov-2 were selected, and as the\u0000chosen language, English.\u0000Results: From the total of researched studies, 65 articles were selected, one being presented in two databases\u0000simultaneously. As a final result of this review, 11 articles were included, with a population total estimated\u0000at 84.050 patients, with the prevalence of smokers ranged from 1.4% to 27.3% and it was observed that the\u0000impact of smoking on fatal outcomes was described in four publications, with unfavourable repercussions\u0000on hospitalization rates and more serious conditions secondary to COVID-19 (9 out of the 11 publications\u0000evaluated).\u0000Conclusion: The presence of smoking can worsen infectious conditions by COVID-19 and increase\u0000the prevalence of hospitalizations and fatal outcomes, especially in men, the elderly and those with\u0000multimorbidities. Smoking status should be used in the screening of patients infected with the novel\u0000coronavirus given the evidence of poorer outcomes among smokers.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48561259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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