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Ahmed Almarzuqi,1 Shane Kimber,1 Kenneth Quadros,1 Janek Senaratne1,2 1Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; 2Department of Critical Care Medicine, University of Alberta, Edmonton, CanadaCorrespondence: Janek Senaratne, Tel +1 (780) 463-2184, Fax +1 (780) 450-8359, Email janeks@ualberta.caAbstract: Bidirectional ventricular tachycardia (BiVT) is a rare form of ventricular tachycardia that manifests on surface electrocardiogram by dual QRS morphologies alternating on a beat-to-beat basis. It was first reported in the 1920s as a complication of digoxin, and since then, it has been reported in other conditions including fulminant myocarditis, sarcoidosis, catecholaminergic polymorphic ventricular tachycardia, and Andersen-Tawil syndrome. The mechanism for BiVT is not as well known as other forms of ventricular tachycardia but appears to include typical mechanisms including triggered activity from afterdepolarizations, abnormal automaticity, or reentry. This review will go beyond the definition, surface electrocardiogram, mechanisms, causes, and treatment of BiVT as per our current understanding.Keywords: bidirectional ventricular tachycardia, dual reentry, ventricular arrhythmia, digoxin toxicity, catecholaminergic polymorphic ventricular tachycardia

Mitsuru Seki, Takaomi Minami Department of Pediatrics, Jichi Medical University, Tochigi, JapanCorrespondence: Mitsuru Seki, Department of Pediatrics, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan, Tel +81-285-58-7366, Fax +81-285-44-6123, Email m-seki@jichi.ac.jpAbstract: Kawasaki disease (KD), first reported as an acute febrile mucocutaneous lymph node syndrome, is a self-limiting vasculitis of unknown etiology. The most important aspect of KD is the prevention of coronary artery lesion (CAL) because myocardial ischemia or infarction due to CAL might be lethal. In addition to the CAL, patients with KD develop systemic vasculitis, which indicates the presence of vascular endothelial damage. Studies assessing pulse wave velocity or percentage change in flow-mediated dilatation have shown that aortic stiffness is increased in patients with KD history. In contrast, the cardio-ankle vascular index, a novel parameter not affected by blood pressure, has not demonstrated increased aortic stiffness in patients with KD. Although many studies using various parameters have suggested a risk of atherosclerosis in patients with a history of KD, a few others have reported no significant differences between KD patients and controls. Therefore, it will be necessary to thoroughly understand the characteristics of each parameter, before evaluating the results of those studies, to understand systemic vascular dysfunction in these populations, and to manage their vascular health. Although it is controversial whether the risk of atherosclerosis in patients with KD is higher, those with CAL are thought to be at a high risk of atherosclerosis. Therefore, appropriate treatment to prevent CAL in the acute phase and subsequent regular follow-up is important. Here, we review the pathology, risk, and management of vascular disorders, especially systemic vascular disorders, in patients with KD history.Keywords: vasculitis, aortic stiffness, atherosclerosis, v

Xinran Li,* Jiamin Zheng,* Ye Lu, Xiangtao Pan Department of Hematology and Oncology, Suzhou Medical College of Soochow University, Taicang Hospital Affiliated of Soochow University, Taicang City, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiangtao Pan, Department of Hematology and Oncology, Suzhou Medical College of Soochow University, Taicang Hospital Affiliated of Soochow University, Taicang City, Jiangsu Province, 215400, People’s Republic of China, Tel +86 18915768003, Email panxiangtao@csco.ac.cnObjective: To investigate the risk of death in patients with tumor-related PTE (pulmonary thromboembolism) detected by CAR (C-reactive protein/albumin ratio) combined with DD (D-dimer).Methods: The peripheral hematology and coagulation-related indexes of 109 patients with tumor-related PTE diagnosed by PTCA were retrospectively analyzed, and the differences in relationship indexes between tumor-related PTE patients with good prognosis and poor prognosis were compared and analyzed. The receiver operating characteristic curve (ROC) was used to analyze the risk of death in patients with tumor-related PTE by CAR and DD.Results: â‘ The values of CAR and DD in the poor prognosis group were 3.90 ± 2.69 and 21.25 ± 21.20, respectively, which were significantly higher than those in the good prognosis group (1.66 ± 1.77, 9.53 ± 3.57) (P all < 0.01). â‘¡ WBC, NE and SII in tumor-related PTE patients with poor prognosis were significantly higher than those in patients with good prognosis, while Hb in patients with poor prognosis was significantly lower than that in patients with good prognosis. â‘¢ There was a significant positive correlation between CAR and DD (P=0.018). â‘£ The values of CAR and DD in the death group were 4.07 ± 2.42 and 19.65 ± 20.48, respectively, which were significantly higher than those in the survival

Tuti Pahria,1 Cahyo Nugroho,1,2 Desy Indra Yani1 1Faculty of Nursing, Universitas Padjadjaran, Jatinangor, 45363, Indonesia; 2Nursing Management Team, Majenang Hospital, Majenang, 53257, IndonesiaCorrespondence: Desy Indra Yani, Faculty of Nursing, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang KM 21, Jatinangor, 45363, Indonesia, Tel/Fax +62 22-7796647, Email desy.indra.yani@unpad.ac.idAbstract: Purpose: While hypertension with accompanying complications remains a life-threatening illness, a critical program in its management and prevention is implementing self-care behaviors (SCBs). This study examined the factors associated with SCB that are dominant in hypertension patients with complications.Materials and Methods: This quantitative study was conducted using the regression analytic method and a cross-sectional approach. The non-probability sampling technique was used, and the response rate was 96.2%. Data were collected using a modified hypertension self-care profile (HBP-SCP) questionnaire, hypertension knowledge questionnaire, family support questionnaire, and the brief-illness perception questionnaire (B-IPQ).Results: The mean total SCB score was high at 55.9% with a mean of 191.01, SD = 5.16; 77.5% of the respondents had no disease history, 80.4% had good knowledge, 58.8% had strong family support, and 50% had a good perception of the disease. Factors that were significantly related to SCB were family support (p = 0.00, r = 0.75) and illness perception (p = 0.00, r = 0.77), while disease history (r = 0.47) and knowledge were not significantly related (r = 0.13). Moreover, the analysis of multiple linear regression with the backward method showed that the most dominant factor influencing SCB was illness perception (p = 0.00, = 0.47, B = 0.495, R2 = 0.650). The effect of illness perception on SCB (65%) meant that each 0.50 perception score increased the SCB score by one.Conclusion: It is recommended that health workers increase patient perception using inn

Mohamed Sheikh Hassan, Abdiladhif Mohamed Ali, Mohamed Farah Osman, Abdulkadir Ahmed Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Mohamed Sheikh Hassan, Email dr.m.qalaf@gmail.comIntroduction: The basal ganglia, which comprise many subcortical nuclei, constitute an integrated functional unit of the brain. Spontaneous hemorrhage of the basal ganglia is mostly unilateral and secondary to uncontrolled hypertension. Simultaneous bilateral basal ganglia hemorrhage (SBBGH) is very rare. So far, only 40 cases have been documented so far.Case Presentation: Here, we report a 37-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion, and right-sided weakness for 2 days. An urgent non-contrast brain CT performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the basal ganglia. On admission, blood pressure was 220/120. Other vital signs were normal. The patient was admitted to the ICU, IV antihypertensive and antiedema medications were given. After clinical improvement, he was transferred to the neurology ward on the fifth day. After another 5 days in the neurology inpatient ward, the patient clinically improved and was referred to the rehabilitation department.Conclusion: Due to the rarity of SBBGH, it is particularly interesting to report this remarkable case of a man with simultaneous spontaneous bilateral ganglia hemorrhage secondary to uncontrolled hypertension.Keywords: uncontrolled hypertension, bilateral basal ganglia, hemorrhagic stroke

Hawa Nuradin Mohamed,1 Ahmed Muhammad Bashir,1 Yahye Garad Mohamed2 1Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia; 2Department of Radiology, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Muhammad Bashir, Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia, Email ambashir@hotmail.comAbstract: Nephrotic Syndrome (NS) patients are prone to develop deep venous thrombosis as a complication. But it is unusual to present initially with multiple venous thrombosis and pulmonary artery thrombosis before the diagnosis of NS. Here, we present 60 years old female patient with a known history of diabetes mellitus who presented with shortness of breath and lower limb edema for 2 weeks. CT angiography showed thromboembolism at the right main pulmonary artery and its bronchus intermedius, lower and segmental with right lower lobe small pulmonary infarction and inferior vena cava (IVC) thrombosis extending in both renal veins, right common and left common iliac vein, moderate ascites. Her 24-hour urinary protein was 6.7g. a diagnosis of NS was reached and she was admitted to the ward. Anticoagulation with heparin and warfarin, methyl prednisone, and furosemide was initiated. After she become clinically stable, she was discharged with oral medications. Awareness of the complication of nephrotic syndrome is important not only to nephrologists but to all physicians. Using contrast-enhanced computed tomography to diagnose multiple venous and pulmonary arterial thrombosis is critical. Additionally, it is known that steroid-resistant NS, like membranous glomerulonephritis, are more susceptible to the complication of thromboembolism than steroid-sensitive NS. Contrast venography is used to diagnose DVT. CTPA is the gold standard test for pulmonary embolism.Keywords: pulmonary artery thrombosis, nephrotic syndrome, multipl

Xiaoming Jia,1 Mahmoud Al Rifai,1 Anum Saeed,2 Christie M Ballantyne,1 Salim S Virani1,3 1Department of Medicine, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USACorrespondence: Salim S Virani, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA, Tel +1 713-440-4410, Email virani@bcm.eduAbstract: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are potent medications in the toolkit for treatment of atherosclerotic cardiovascular disease. These agents have been well studied in clinical trials supporting their efficacy in dramatically reducing low-density lipoprotein cholesterol (LDL-C) and impact on cardiovascular outcomes. Since the approval of commercial use for PCSK9 inhibitors in 2015, we have also gained significant experience in the use of these therapeutics in the real-world setting. In this article, we review current guideline recommendations, clinical trial evidence on efficacy and safety as well as data on cost-effectiveness, prescription and adherence. We focus primarily on the monoclonal antibody class of PCSK9 inhibitors in this review while also touching on other types of therapeutics that are under development.Keywords: PCSK9 inhibitor, CVD prevention, lipids

Syed Sajid Hussain Kazmi,1,2 Nathkai Safi,1,2 Simen Tveten Berge,1,2 Marryam Kazmi,1,3 Jon Otto Sundhagen,1 Kari Julien,4 Per Medbøe Thorsby,2,4 Kim Vidar Ånonsen,5 Asle Wilhelm Medhus,2,5 Jonny Hisdal1,2 1Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Faculty 2, Poznan University of Medical Sciences, Poznan, Poland; 4The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker, Oslo, Norway; 5Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, NorwayCorrespondence: Syed Sajid Hussain Kazmi, Tel +47 92468309, Email sshkazmi@gmail.comBackground: Chronic mesenteric ischemia (CMI) due to either atherosclerosis of the mesenteric arteries or median arcuate ligament syndrome (MALS) is an underdiagnosed entity. The etiology of MALS and its existence have been debated and questioned. We aimed to identify plasma biomarkers indicating mesenteric ischemia in patients with CMI and MALS.Methods: Plasma α-glutathione S-transferase (α-GST), intestinal fatty acid-binding protein (I-FABP), citrulline, and ischemia modified albumin (IMA) were analyzed in fifty-eight patients with CMI (Group A, n=44) and MALS (Group B, n=14) before and after revascularization. The plasma levels of these potential biomarkers were compared with those of healthy individuals (Group C, n=16). Group comparison was performed with the Mann–Whitney U-test. Cross-tabulation and its derivatives were obtained. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated.Results: Plasma levels of α-GST were significantly raised in the patients with CMI (7.8 ng/mL, p< 0.001) and MALS (8.4 ng/mL, p< 0.001), as compared with the control Group C (3.3 ng/mL). The threshold for normal median plasma α-GST levels of 4 ng/mL yielded a sensitivity of 93%

Abdul Ghafar Sherzad,1,2 Muhibullah Shinwari,3 M Azim Azimee,2 Arash Nemat,1,4 Qingchun Zeng1,5 1Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Biochemistry, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan; 3Department of Physiology, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan; 4Department of Microbiology, Kabul University of Medical Sciences, Kabul, Afghanistan; 5Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 5100050, People’s Republic of ChinaCorrespondence: Abdul Ghafar Sherzad, Department of Biochemistry, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan, Tel +937 83545284, Email ghafarsherzad15@gmail.com Qingchun Zeng, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 Northern, Guangzhou Ave, Guangzhou, 510515, People’s Republic of China, Tel/Fax +86 20-61360416, Email qingchunzeng@smu.edu.cnObjective: Evidence from previous studies suggests that calcific aortic valve disease (CAVD) is not an unavoidable consequence of aging, and may be linked to explicit risk factors. However, little is known regarding the Afghan population in this context. The current study aimed to identify the clinical features of CAVD and determine independent risk factors for CAVD in the Afghan population.Patients and Methods: A case-control study was conducted among 1072 Afghan participants (age > 18 years) from January 2018 to December 2020. The study participants were divided into two groups based on echocardiographic findings: 536 individuals with CAVD and 536 age- and sex-matched controls. Data were collected using questionnaires from the medical records of all cases and controls. The independent predictors of CAVD were evaluated using multivariate logistic regression analysis.Results: The mean age of study participants was 65.

Jariya Waisayarat,1 Chayakamon Niyasom,2 Soamarat Vilaiyuk,2 Sani Molagool3 1Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Jariya Waisayarat, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajathevee, Bangkok, 10400, Thailand, Tel +66 2 201 1432, Fax +66 2 354 7266, Email jariya.wai@mahidol.ac.thAbstract: Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis affecting small- to medium-sized arteries. The most common gastrointestinal manifestation of PAN is postprandial abdominal pain from mesenteric arteritis causing bowel ischemia. When transmural ischemia develops, there may be ischemic necrosis and perforation of the bowel wall, which are life-threatening. Severe, life-threatening gastrointestinal involvement is relatively rare in pediatric PAN and may require different management in adult patients. We report a pediatric PAN case in a patient who presented with acute abdominal pain and superimposed cytomegalovirus enteritis with jejunoileal perforation. The patient improved with emergency small intestinal resection followed by conventional immunosuppressive drugs of a corticosteroid and cyclophosphamide, and anti-viral drugs. Before increasing the immunosuppressive drug dosage, initial screening of infectious cytomegalovirus and comprehensive evaluation for surgical conditions are essential in pediatric PAN with severe gastrointestinal involvement. Early aggressive treatment for acute abdomen is useful in reducing morbidity and mortality in pediatric PAN.Keywords: polyarteritis nodosa, cytomegalovirus enteritis, abdominal pain, bowel perforation

Marek Czajkowski,1 Wojciech Jache&cacute;,2 Anna Polewczyk,3,4 Jaros&lstrok;aw Kosior,5 Dorota Nowosielecka,6 &Lstrok;ukasz Tu&lstrok;ecki,7 Pawe&lstrok; Stefa&nacute;czyk,6 Andrzej Kutarski8 1Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland; 2Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland; 3Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland; 4Department of Cardiac Surgery, &Sacute;wi&eogon;tokrzyskie Center of Cardiology, Kielce, Poland; 5Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, Poland; 6Department of Cardiology, The Pope John Paul II Province Hospital of Zamo&sacute;&cacute;, Zamo&sacute;&cacute;, Poland; 7Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamo&sacute;&cacute;, Zamo&sacute;&cacute;, Poland; 8Department of Cardiology, Medical University of Lublin, Lublin, PolandCorrespondence: Anna Polewczyk, Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Aleja IX Wieków Kielc 19A, Kielce, 25-317, Poland, Tel +48600024074, Email annapolewczyk@wp.plBackground: Lead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO.Methods: We performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO.Results: Mild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/sev

Li X, Zheng J, Lu Y, Pan X. Vasc Health Risk Manag. 2022;18:445-451. The authors have advised that there is a typographical error in the Abstract on page 445. Methods section, line 1, the text “PTCA” should read “CTPA”. The authors apologize for this error. Read the original article

Ikram U Haq,1 Karanjot Chhatwal,2 Krishna Sanaka,3 Bo Xu4 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA; 2Imperial College London School of Medicine, London, SW7 2AZ, UK; 3Emory University, Atlanta, GA, 30322, USA; 4Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USACorrespondence: Bo Xu, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA, Tel +1 216 444-2200, Fax +1 216 445-6152, Email xub@ccf.orgAbstract: Cardiovascular disease (CVD) represents a significant and increasing burden on healthcare systems. Artificial intelligence (AI) is a rapidly evolving transdisciplinary field employing machine learning (ML) techniques, which aim to simulate human intuition to offer cost-effective and scalable solutions to better manage CVD. ML algorithms are increasingly being developed and applied in various facets of cardiovascular medicine, including and not limited to heart failure, electrophysiology, valvular heart disease and coronary artery disease. Within heart failure, AI algorithms can augment diagnostic capabilities and clinical decision-making through automated cardiac measurements. Occult cardiac disease is increasingly being identified using ML from diagnostic data. Improved diagnostic and prognostic capabilities using ML algorithms are enhancing clinical care of patients with valvular heart disease and coronary artery disease. The growth of AI techniques is not without inherent challenges, most important of which is the need for greater external validation through multicenter, prospective clinical trials.Keywords: artificial intelligence, cardiovascular medicine, machine learning, neu

Abdulaziz Mohammad Al-Sharydah,1 Hussain Khalid Al-Arfaj,2 Sari Saleh Al-Suhibani,1 Fahad Safran Al-Safran,2 Abdulrahman Hamad Al-Abdulwahhab,1 Saeed Ahmad Al-Jubran,1 Abdulhadi Ahmad AlSaflan3 1Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar City, Eastern Province, Saudi Arabia; 2Medical Imaging Department, King Fahd Specialist Hospital, Dammam City, Eastern Province, Saudi Arabia; 3Anesthesia Department, King Fahd Hospital of the University, Khobar City, Eastern Province, Saudi ArabiaCorrespondence: Abdulaziz Mohammad Al-Sharydah, Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 31952 (4398), Khobar City, Eastern Province, Saudi Arabia, Tel +966 566473111, Fax +966 13-8676697, Email Amsharydah@iau.edu.saPurpose: Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD).Patients and Methods: This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded.Results: A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initi

Lubna Al Asoom Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Al Asoom, Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. 2114, Dammam, 31541, Saudi Arabia, Tel +966 133335131, Email lasoom@iau.edu.saAbstract: Obesity is one of the major health-threatening conditions nowadays. Nigella sativa (NS) is a medicinal plant that demonstrates multiple therapeutic effects. In the current review, we aim to evaluate the weight lowering effect of NS in both clinical trials and experimental studies and to explore the possible reported mechanisms of this effect. We searched PubMed and Web of science and retrieved 14 clinical trials and 5 experimental studies that justify our inclusion criteria. After the analysis of these articles, we can conclude that long-term administration of NS for 6– 12 weeks can significantly lower bodyweight and other anthropometric indices. NS-oil is more potent than NS-powder in lowering bodyweight probably due to the higher concentration of fatty acids and thymoquinone. The weight lowering effect of NS is not a toxic effect, it conversely and preferably lowers the elevated liver enzymes in condition of fatty liver. It is also frequently accompanied by positive metabolic modifications, such as enhancement of lipid profile, lowering blood glucose and improving insulin resistance. Possible mechanisms for NS-bodyweight lowering effect might include an appetite-suppression effect, lowering caloric-intake and inhibition of intestinal glucose absorption. However, further experimental evidence is required to support these mechanisms or unveil new ones.Keywords: Nigella sativa, obesity, bodyweight, BMI, waist-circumference

Lina Shibib,1 Mo Al-Qaisi,1 Ahmed Ahmed,1 Alexander D Miras,2 David Nott,1 Marc Pelling,1 Stephen E Greenwald,3 Nicola Guess4 1Department of Surgery and Cancer, Imperial College London, London, UK; 2Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; 3Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK; 4School of Life Sciences, Westminster University, London, UKCorrespondence: Mo Al-Qaisi, Imperial Weight Centre, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK, Tel +44 7968 016315, Email mrcgp74@yahoo.co.ukAbstract: Over the past 50 years, many countries around the world have faced an unchecked pandemic of obesity and type 2 diabetes (T2DM). As best practice treatment of T2DM has done very little to check its growth, the pandemic of diabesity now threatens to make health-care systems economically more difficult for governments and individuals to manage within their budgets. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the World Health Organization (WHO) global report on diabetes added for the first time a section on diabetes reversal and acknowledged that it could be achieved through a number of therapeutic approaches. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. However, T2DM reversal is not yet a standardized area of practice and some questions remain about long-term outcomes. Diabetes reversal through diet is not articulated or discussed as a first-line target (or even goal) of treatment by any internationally recognized guidelines, which are mostly silent on the topic beyond encouraging lifestyle interventions in general. This review paper examines all the sustainable, practical, and scalable approaches to T2DM reversal, highlighting the evidence base, and serves as an interim update for practitioners l

Mingfang Li,1 Jiaojiao Shi,1 Ming Chu,1 Youmei Shen,1 Shimeng Zhang,1 Xingxing Sun,1 Hengli Zhang,1 Qing Yan,1 Jinlong Gong,2 Gregory YH Lip,3,4 Minglong Chen1,5 1Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Division of Cardiology, Jiangdu People’s Hospital, Yangzhou, People’s Republic of China; 3Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; 4Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 5Division of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of ChinaCorrespondence: Minglong Chen, Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86-25-68303115, Fax +86-25-6813-6479, Email chenminglong@njmu.edu.cnAbstract: China has a large population of elderly in rural areas. Village doctors are acting as health-care gatekeepers for the rural elderly in China and are encouraged to provide more long-term care for patients with chronic diseases such as atrial fibrillation (AF). The data of AF registries from the rural elderly are limited. The present registry aims to provide contemporary data on the current AF-related health status of the rural elderly and the gaps in management of AF by village doctors. This study has two phases. The first phase is a cross-sectional study of AF screening in two rural towns of eastern China. All the residents aged ≥ 65 years are eligible and will be invited to attend a government-led health examination or an in-house AF screening program. The AF detection rate, the awareness of AF and the usage of oral anticoagulants and smartphones by AF patients, and the ability to diagnose and manage AF by village doctors will be assessed. Participants with AF detected in the first phase are eligible for the second phase

Jorge Enrique Daza-Arana,1 Heiler Lozada-Ramos,2,3 Daniel Felipe Ávila-Hernández,1 Leidy Tatiana Ordoñez-Mora,1 Diana Patricia Sánchez1 1Physiotherapy Program, Universidad Santiago de Cali, Cali, Colombia; 2Medicine Program, Universidad Santiago de Cali, Cali, Colombia; 3Doctoral Program in Infectious Diseases, Universidad de Santander – UDES, Bucaramanga, ColombiaCorrespondence: Jorge Enrique Daza-Arana, Physiotherapy Program, Universidad Santiago de Cali, Calle 5 No. 62-00 Pampalinda, Cali, Colombia, Tel +57 3108923676, Email jorgedaz921@gmail.comPurpose: The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft.Patients and Methods: This was an analytical retrospective case–control study. Cases were defined as subjects requiring prolonged mechanical ventilation (> 48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery.Results: A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06– 3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: − 3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73– 7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation < 60% (OR 2.00; 95% CI: 1.18– 3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06– 84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77– 4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02– 6.32, p = 0.00) and delirium (OR 3.45; 95% CI

Maciej Antkiewicz,1 Marcin Protasiewicz,2 Wiktor Kuliczkowski,2 Tomasz Zubilewicz,3 Piotr Terlecki,3 Magdalena Kobielarz,4 Dariusz Janczak1 1Department and Clinic of Vascular, General and Transplantation Surgery, Wroc&lstrok;aw Medical University, Wroc&lstrok;aw, Poland; 2Department and Clinic of Cardiology, Wroc&lstrok;aw Medical University, Wroc&lstrok;aw, Poland; 3Department and Clinic of Vascular Surgery and Angiology, Medical University of Lublin, Lublin, Poland; 4Department of Mechanics, Materials Science and Biomedical Engineering, Wroc&lstrok;aw University of Science and Technology, Wroc&lstrok;aw, PolandCorrespondence: Maciej Antkiewicz, Department and Clinic of Vascular, General and Transplantation Surgery, Wroc&lstrok;aw Medical University, Borowska 213, Wroc&lstrok;aw, 50-556, Poland, Tel +48 71 733 2003, Fax +48 71 733 2009, Email maciej.antkiewicz@gmail.comPurpose: Numerous cases of abdominal aortic aneurysm (AAA) enlargement, and even rupture, despite endovascular aneurysm repair (EVAR), have been documented. This has been linked to increased aneurysm sac pressure (ASP). We decided to conduct further research with the aim to identify correlations between ASP during EVAR and subsequent aneurysm enlargement.Patients and Methods: This experimental prospective study included 30 patients undergoing EVAR of infrarenal AAAs. Invasive ASP measurements were done using a thin pressure wire. Aortic pressure (AP) was measured using a catheter placed over the wire. Systolic pressure index (SPI), diastolic pressure index (DPI), mean pressure index (MPI), and pulse pressure index (PPI) were calculated both for ASP and AP. The results of follow-up computed tomography angiography (CTA) at 3 months were compared with baseline CTA findings.Results: During EVAR, a significant reduction was observed for SPI (from 98% to 61%), DPI (from 100% to 87%), MPI (from 99% to 74%), and PPI (from 97% to 34%). There were no significant correlations of

Khalid S Ibrahim,1 Khalid A Kheirallah,2 Mahmoud A Megdadi2 1Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Khalid S Ibrahim, Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan, Tel +962 79 6 42 77 00, Email Ksibrahim@just.edu.joBackground: Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity.Patients and Methods: The study cohort included patients with rheumatic valve pathology such as stenosis and regurgitation. All patients underwent valvular surgical procedures including mitral valve replacement (MVR), aortic valve replacement (AVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with or without CABG. This study included patients who underwent surgery between 2002 and 2017.Results: Three hundred and forty-six patients were included in this study. The mean patient age was 51.6± 16.1 years; 37% of the patients underwent AVR, 28% underwent MVR, and 13% underwent a combination of MVR with AVR, AVR with CABG in 6%, and MVR with CABG in 10%. The operative mortality rate was 5.8% (n=20). Univariate analysis revealed that the predictors of mortality included age (P < 0.001), body mass index (BMI) (P = 0.003), type of surgery performed (P = 0.007), hypertension (P = 0.005), emergent surgeries (P = 0.018), left atrial diameter (P = 0.003), cross-clamp time greater than 90 minutes (P = 0.007), postoperative acute kidney injury (AKI) (P = 0.044), postoperative stroke (P = 0.049), and surgical site infection (P = 0.047). Multivariate analysis revealed that predictors of mortality included age (P = 0.028

Temirkhan Begisbayev,1 Lyazzat Kosherbayeva,2,3 Kamilla Gaitova,4 Marzhan Brimzhanova1 1Kazakhstans Medical University “KSPH”, Almaty, Kazakhstan; 2Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 3Al-Farabi Kazakh National University, Almaty, Kazakhstan; 4Health Technology Assessment Department, Republican Center for Health Development, Nur-Sultan, KazakhstanCorrespondence: Lyazzat Kosherbayeva, Asfendiyarov Kazakh National Medical University, 88 Tole bi Street, Almaty, Kazakhstan, Tel + 7 705 120 46 52, Email lyazzat.k@mail.ru; kosherbaeva.l@kaznmu.kzAbstract: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. The implementation of effective technologies such as Implantable cardioverter-defibrillator (ICD) for patients at risk of sudden cardiac death requires additional health system resources.Objective: To assess the economic effectiveness of ICD in comparison with conservative tactics for preventing life-threatening rhythm disturbances in Kazakhstan.Methods: A Markov model was built with a time horizon of 35 years. Mortality and utility data were obtained from the available literature. The economic parameters of the model are based on the approved tariffs for medical services in Kazakhstan and clinical protocols. Following WHO recommendations, a willingness to pay threshold of three times gross domestic product per capita was used to assess cost-effectiveness. A discount rate of 3.5% was applied to both costs and benefits. To deal with parameter uncertainties and to provide robust analysis, a probabilistic sensitivity analysis was performed, randomly varying all inputs subject to uncertainty assuming a statistical distribution.Results: The total costs in the primary prevention (PP) group by ICD implantation and in the control group were 8,903,786 tenges and 3,194,414 tenges, respectively. The discounted total quality-adjusted life-years saved (QALYs) in the ICD and control groups were 6.48 and 4.98, respecti

Carolina Hungaro Cunha,1 Debora Yuri Sato,1 Jose Maria Pereira de Godoy,2 Gleison Juliano da Silva Russeff,1 Desirée Franccini Del Frari Silva,1 Henrique Jose Pereira de Godoy,3 Mariana Orate Menezes da Silva,4 Henrique Amorim Santos,4 Maria de Fatima Guerreiro Godoy5 1Ecography Service in Hospital de Base-FUNFARME/FAMERP, Sao Jose do Rio Preto, Brazil; 2Cardiology and Cardiovascular Surgery Department Sao Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 3General Surgery Department São Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 4Vascular Surgery Service São Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, Brazil; 5Post-Graduate Program São José do Rio Preto-FAMERP, Sao Jose do Rio Preto School Medicine-FAMERP, Sao Jose do Rio Preto, BrazilCorrespondence: Jose Maria Pereira de Godoy, Cardiology and Cardiovascular Surgery Department São Jose do Rio Preto School Medicine-FAMERP, Rua Floriano Peixoto, São Jose do Rio Preto, SP, 2950, Brazil, Tel/Fax +551732326362, Email godoyjmp@gmail.comPurpose: The SARS-CoV-2 disease predisposes infected individuals to thrombosis, the underlying mechanisms of which are not fully understood. The balance between pro-coagulant factors and natural coagulation inhibitors in critically ill patients with Covid-19 is fundamental to the prevention and treatment of complications. The aim of the present study was to investigate the pulmonary injury patterns in Covid-19 having higher mortality in the presence of deep vein thrombosis in comparison to patients without venous thrombosis and determine the Gamma variant.Methods: A retrospective study was conducted involving the evaluation of 200 medical records of patients with Covid-19 and a clinical suspicion of deep vein thrombosis (DVT) at the intensive care unit of a public hospital. The sample was divided into two groups of patients were formed – those positive and those negative for DVT. Statistical analysis involved

Abdallah Damin Abukhalil Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, PalestineCorrespondence: Abdallah Damin Abukhalil, Email adkhalil@birzeit.edu

Alper Tuna Güven,1 Murat Özdede2 1BaÅŸkent University Adana Hospitals, Department of Internal Medicine, Adana, Turkey; 2Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Ankara, TurkeyCorrespondence: Alper Tuna Güven, Email alper.tuna.guven@gmail.com

Abdallah Damin Abukhalil, Alisse Nasser,&ast; Hadeel Khader,&ast; Miral Albandak,&ast; Raed Madia, Ni’meh Al-Shami, Hani A Naseef Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine&ast;These authors contributed equally to this workCorrespondence: Abdallah Damin Abukhalil; Raed Madia, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Tel +970-598204036 ; +970-5114848, Fax +970-2-2982017, Email Adkhalil@birzeit.edu; rmadia@birzeit.eduIntroduction: Venous thromboembolism (VTE) is the most preventable complication in hospitalized patients. The main objective of this study was to evaluate the adherence of current clinical practice to the established guidelines at a Palestinian teaching hospital.Methods: This cross-sectional, retrospective, observational study was conducted at a Palestinian Teaching Hospital. The medical records of patients admitted to the medical floor over 18 years of age and hospitalized for longer than 24 hours between January 1 and May 31, 2019, were included. Patients taking anticoagulants with incomplete or duplicated medical records were excluded from the study. A data collection sheet was developed, and clotting and bleeding risks were assessed using the Padua and IMPROVE risk assessment models (scores). The data were analyzed using IBM SPSS (version 25).Results: In total, 408 patients were included in the study, 222 of whom received thromboprophylaxis (54.4%). Of the hospitalized patients, 112 (27.5%) had a high risk of developing VTE (Padua score ≥ 4), and 73 patients were eligible for VTE pharmacological prophylaxis; however, only 44 (60.3%) received the appropriate prophylaxis. In addition, 296 patients had low Padua scores, indicating that pharmacological prophylaxis was not indicated. However, 144 (48.6%) patients received prophylaxis. The mean Padua and IMPROVE risk scores w

Michal Chudzik,1,2 Anna Cender,1 Robert Mordaka,1 Jacek Zielinski,3 Joanna Katarzynska,4 Andrzej Marcinek,4,5 Jerzy Gebicki4,5 1Medical Center, Saint Family Hospital, Lodz, Poland; 2Department of Internal Medicine and Geronto-Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland; 3Department of Athletics, Strength and Conditioning, Poznan University of Physical Education, Poznan, Poland; 4Angionica Ltd., Lodz, Poland; 5Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, PolandCorrespondence: Jerzy Gebicki, Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, 90-924, Poland, Tel +48 42 631 31 71, Email jerzy.gebicki@p.lodz.pl; jerzy.gebicki@angionica.com.pl Michal Chudzik, Department of Internal Medicine and Geronto-Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland, Tel +48 691 941 814, Email michalchudzik@wp.plPurpose: The pathophysiology of chronic fatigue associated with post-COVID syndrome is not well recognized. It is assumed that this condition is partly due to vascular dysfunction developed during an acute phase of infection. There is great demand for a diagnostic tool that is able to clinically assess post-COVID syndrome and monitor the rehabilitation process.Patients and Methods: The Flow Mediated Skin Fluorescence (FMSF) technique appears uniquely suitable for the analysis of basal microcirculatory oscillations and reactive hyperemia induced by transient ischemia. The FMSF was used to measure vascular circulation in 45 patients with post-COVID syndrome. The results were compared with those for a group of 26 amateur runners before and after high-intensity exercise as well as for a control group of 32 healthy age-matched individuals.Results: Based on the observed changes in the NOI (Normoxia Oscillatory Index) and RHR (Reactive Hyperemia Response) parameters measured with the FMSF technique, it was found that chronic fatigue associated with post-COVID syndrome is comparab

Edoardo Pasqui, Gianmarco de Donato, Brenda Brancaccio, Giulia Casilli, Giulia Ferrante, Alessandro Cappelli, Giancarlo Palasciano Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, ItalyCorrespondence: Edoardo Pasqui, Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci, Siena, 53100, Italy, Tel +39 3428009201, Email pasqui11@student.unisi.it; edopas@hotmail.itAbstract: Background: Post-operative delirium (POD) is a common complication, especially in elderly patients who underwent vascular surgery procedures. The aim of this study was to evaluate the relation of inflammatory biochemical markers as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammation index (SII) with POD occurrence.Methods: This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective vascular surgery procedures. The occurrence of delirium after procedure was used to divide the population in two groups: POD-pos and POD-neg group. ROC curves were performed to find the appropriate cut-off values of NLR, PLR and SII. Multivariate analysis was used to identify the independent predictors for POD.Results: A total of 646 patients were enrolled. Mean age was 76.2± 9.8 years, 68.4% were male. Seventy-three patients (11.3%) developed POD. Mean hospital stay was significantly increased in the POD-pos group (6.1± 5.4 vs 3.2± 2.8 days, p=0.0001). In-hospital reinterventions were more frequent in the POD-pos group (8.2% vs 3.8%). Blood values analysis reported significant differences: Hb, NLR, PLR, SII, creatinine and RCP were strongly increased (p< 0.05) in the POD-pos group. ROC curves identified cut-off values for NLR> 3.57, PLR> 139.2 and SII> 676.4. Multivariate analysis revealed that age, Renal Failure, peripheral revascularization procedures, major amputation, general ane

Michael R Sood,1,2 Sahar S Abdelmoneim,1 Nripen Dontineni,1 Alexander Ivanov,1 Ernest Lee,1 Michael Rubin,1 Michael Vittoria,1 Marcella Meykler,1 Vidhya Ramachandran,1 Terrence Sacchi,1 Sorin Brener,1 Igor Klem,3 John F Heitner1,4 1Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA; 2Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA; 3Duke University, Raleigh Durham, NC, USA; 4Division of Cardiology, New York University-Langone Health, Brooklyn, NY, USACorrespondence: Michael R Sood, Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA, Email mike.sood@gmail.comBackground: Aortic distensibility (AD) is an important determinant of cardiovascular (CV) morbidity and mortality. There is scant data on the association between AD measured within the descending thoracic aorta and CV outcomes.Objective: We evaluated the association of AD at the descending thoracic aorta (AD desc) with the primary outcome of all-cause mortality, myocardial infarction (MI), stroke or coronary revascularization in patients referred for a cardiovascular magnetic resonance (CMR) study.Methods: 928 consecutive patients [(mean age 60 ± 17; 33% with prior cardiovascular disease (CVD))] were evaluated. AD desc was measured at the cross-section of the descending thoracic aorta in the 4-chamber view (via steady-state free precession [SSFP] cine sequences) and was grouped into quintiles (with the 1st quintile corresponding to the least AD, i.e., the stiffest aorta). Cox proportional-hazards regression analysis were performed for the primary outcome.Results: A total of 315 patients (34%) experienced the primary outcome during a median (25% IQR, 75% IQR) follow-up of 5.0 (0.56, 9.3) years. A decreased AD was significantly associated with hypertension, diabetes, renal disease, and dyslipidemia (p < 0.0001). A primary outcome occurred in 43% of patients with AD desc ≤ median compared to 25% with AD desc > median, p < 0.0001, and in 44% of

Nicolas W Shammas The Midwest Cardiovascular Research Foundation, Davenport, IA, USACorrespondence: Nicolas W Shammas, Research Director, Midwest Cardiovascular Research Foundation, 630 E 4th Street, Suite A, Davenport, IA, 52801, USA, Email shammas@mchsi.comAbstract: Atherectomy is an effective vessel prepping device but not all atherectomy devices are equal. The depth of vessel injury and residual narrowing vary considerably among atherectomy devices with significant implications on outcome. Precision imaging is critical to optimize outcome using atherectomy as a vessel prepping technique. Prospective trials need to test the hypothesis that precision imaging has a significant impact on how operators approach the treatment of infrainguinal arterial disease.Keywords: atherectomy, aggressive debulking, vessel prepping, dissections, residual narrowing, complications, adventitial injury

Nebojsa Tasi&cacute;,1 Jirar Topouchian,2 Danijela Tasic,1 Zorana Kovacevic,1 Marko Filipovic,1 Roland Asmar3 1Cardiology & Clinical Research Department, Cardiovascular Institute « Dedinje », Belgrade, Serbia; 2Diagnosis and Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 3Foundation-Medical Research Institutes (F-MRI) ®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: Electronic devices for blood pressure (BP) measurements must undergo independent clinical validation as recommended by various authorities and scientific societies.Objective: To assess the accuracy of the Combei BP118A device in the general population according to the Universal Standard Validation Protocol.Methods: The new-developed Combei BP118A device measures BP at the brachial level using the oscillometric method. The study was performed according to the “AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018) protocol”. Subjects (n = 88) were recruited to fulfill the age, gender, BP and cuff distribution criteria according to the protocol requirements using the same arm sequential BP measurement method. Differences between observers’ mercury sphygmomanometer reference measurements and device BP values (test versus reference) and their standard deviation (SD) were calculated.Results: Ninety-one subjects were selected, 88 of whom were included. The mean BP differences between the simultaneous observers’ reference measurements were − 0.2 ± 1.7 mmHg for systolic BP (SBP) and − 0.2 ± 1.7 mmHg for diastolic BP (DBP). For validation criterion 1, the mean difference ± SD between the reference and device BP values were 3.6 ± 5.5 mmHg for SBP and 1.4 ± 4.5 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5/4.1 mmHg for SBP/DBP (≤ 5.9/6.8). These results fulfilled the prot

Stephanie L Harrison,1,2 Deirdre A Lane,1– 3 Benjamin JR Buckley,1,2 Kausik Chatterjee,4 Muath Alobaida,1,2,5 Emily Shipley,1,2 Gregory YH Lip1– 3 1Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK; 2Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 4Care of the Elderly Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK; 5Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Stephanie L Harrison, Liverpool Centre for Cardiovascular Science, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK, Email stephanie.harrison@liverpool.ac.ukAbstract: Further research is needed to refine risk prediction models for adverse cardiovascular outcomes following stroke in contemporary clinical practice, such as incident atrial fibrillation (AF), recurrent stroke, and cognitive impairment and dementia. The aims of this study are to prospectively investigate cardiovascular outcomes and risk factors for incident cardiovascular disease in a post-stroke cohort, and to externally validate, refine and expand current risk prediction models for cardiovascular and cardiovascular-related outcomes. The study sample size was based on the development of post-stroke risk prediction models for AF and was calculated as 1222 participants. The study design is a multicentre, prospective, observational cohort study. Participants will be adult patients admitted for ischaemic stroke confirmed by stroke physician or transient ischaemic attack (TIA) confirmed by MRI. Routinely collected data will be used in addition to the completion of simple validated questionnaires by the participants. Follow-up will be undertaken 12-months from the date of admission to hospital, in a

Joanna Katarzynska,1 Jacek Zielinski,2 Andrzej Marcinek,1,3 Jerzy Gebicki1,3 1Angionica Ltd., Lodz, Poland; 2Department of Athletics, Strength and Conditioning, Poznan University of Physical Education, Poznan, Poland; 3Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, PolandCorrespondence: Jerzy Gebicki; Andrzej Marcinek, Institute of Applied Radiation Chemistry, Lodz University of Technology, Lodz, 90-924, Poland, Tel +48 42 631 31 71 ; +48 42 631 30 96, Email jerzy.gebicki@p.lodz.pl; andrzej.marcinek@p.lodz.pl

Parounak Zelveian,1 Jirar Topouchian,2 Zoya Hakobyan,1 Jennifer Asmar,3 Heghine Gharibyan,1 Roland Asmar4 1Preventive Cardiology Dept, Institute of Cardiology Named After Levon Hovhannisyan, Yerevan, Armenia; 2Diagnosis & Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 3Gynecology-Obstetric Dept, Foch Hospital, Suresnes, France; 4Foundation-Medical Research Institutes (F-MRI)®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes (F-MRI) ®, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: Electronic devices for blood pressure (BP) measurements require independent clinical validation as recommended by various authorities/societies, both in general and special populations such as pregnancy.Objective: To assess the accuracy of the Withings BPM Connect device in pregnancy and pre-eclampsia according to the Universal Standard Validation Protocol.Methods: The Withings BPM Connect device measures BP at the brachial level using the oscillometric method. The study was performed according to the so-called “modified AAMI/ESH/ISO (ISO 81060-2:2018) protocol” or the “Universal Standard Protocol”. The validation study included 45 pregnant women in the second and third gestational trimester: 15 with pre-eclampsia, 15 with gestational hypertension and 15 normotensives. Differences between mercury sphygmomanometer BP measurements (reference) and device BP values (test) and their standard deviation (SD) were calculated.Results: The mean differences between the mercury standard and device BP values in pregnancy (n = 45) were − 0.5 ± 5.7 mmHg for systolic BP (SBP) and − 0.8 ± 3.8 mmHg for diastolic BP (DBP). In the preeclamptic patients (n = 15), the mean differences were 0.14 ± 5.5 mmHg for SBP and 0.39 ± 3.7 mmHg for DBP. These results fulfilled the protocol requirements (< 5 ± 8 mmHg).Conclusion: The Withings BPM Connect fulfills the validation protocol criteria in pregnancy

Syed Sajid Hussain Kazmi,1,2 Nathkai Safi,1,2 Simen Tveten Berge,2,3 Marryam Kazmi,1,4 Jon Otto Sundhagen,1 Jonny Hisdal1,2 1Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway; 4Faculty 2, Poznan University of Medical Sciences, Poznan, PolandCorrespondence: Syed Sajid Hussain Kazmi, Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Kirkeveien 166, Oslo, 0450, Norway, Tel +47 92468309, Email sshkazmi@gmail.comBackground: The selection of patients with MALS for surgical treatment depends upon the reliability of the symptom interpretation and the diagnostic work-up. We aimed to follow up the results of the laparoscopic decompression of the patients with MALS.Patients and Methods: In a single-center, 52 consecutive MALS patients were followed-up, prospectively, after transperitoneal laparoscopic decompression. MALS was diagnosed with a computed tomography angiography (CTA) verified stenosis, ≥ 50% of the celiac artery (CA), and with duplex ultrasound, a peak systolic velocity (PSV) ≥ 2.0 m/s. Postoperative, CTA, and duplex ultrasound were performed, and the patients were followed-up at 3, 6, 12 months, and yearly after that.Results: Mean age of the patients was 47 ± 21 years, and 65% were females. The patients had a mean weight loss of 8.4 ± 7.2 kg. Fifty-one patients had the laparoscopic operation with a mean operation time of 102 ± 28 minutes. Forty-seven patients (90%) achieved relief from the symptoms either completely (67%) or partially (23%) at 3– 6 months of follow-up. Significant improvement in postoperative PSV was found compared to the preoperative values, p< 0.001. Five patients (10%) with no immediate effect of the operation, but two of the

Maria Teresa Cacua Sanchez,1 Gustavo Buenahora2 1Vascular Surgery, Ambulatory Surgery Center, Vascular Laboratory Kennedy Hospital, Bogotá, Colombia; 2General Practitioners, Ambulatory Surgery Center, Bogotá, ColombiaCorrespondence: Maria Teresa Cacua Sanchez, Tel +57-1-3057470125, Email mcacua@gmail.comAim: Venous ulcers are the most serious complication of chronic venous insufficiency secondary to venous hypertension and represent between 80% and 90% of all ulcers vascular, having socioeconomic repercussions and on the patient’s quality of life.Objective: To determine the factors associated and complications with the morbidity of patients with venous ulcers CEAP 6 in two health delivery systems in Colombia.Methodology: Observational study retrospective multicenter carried out in two health centers, one under the subsidized scheme and the other under the contributory scheme in patients captured adults over 18 years of age during the years 2018 and 2019 with a diagnosis of chronic venous insufficiency CEAP 6 performing a review to the clinical history up to 4 years before the consultation for vascular surgery of ulcerative pathology.Results: A total of 105 patients were evaluated 52% of the contributory regime and 48% patients of the subsidized regime. With 139 ulcers, 70% were women. The educational level of the population in 77% of the individuals had no schooling or only had primary education. The patients of the subsidized regime belonged to the low socioeconomic stratum vs the middle-class stratum in the contributory regime. 80.5% of the lesions are concentrated in groups less than 25 cm and 19.4% of the cases are located above 50 cm. Dressings and advanced technologies were used in 30.02% of the patients in the contributory scheme compared to 24.35% in the subsidized scheme. 37% of the subsidized scheme had contagion vs 28% of the contributory scheme. The epithelialization rates were 67.27% in the contributory regime compared to 26% in the subsidized regim

Juni Kurniawaty,1 Budi Yuli Setianto,1 Supomo,1 Yunita Widyastuti,1 Cindy E Boom2 1Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Harapan Kita National Heart Center, Jakarta, IndonesiaCorrespondence: Juni Kurniawaty, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia, Tel +62 274 514495, Email juni.kurniawaty@ugm.ac.idBackground: Among cardiac surgery patients, low preoperative left ventricular ejection fraction (LVEF) is common and has been associated with poor outcomes. The objective of this study was to assess the association between LVEF and postoperative mortality in patients undergoing open-heart surgery in several hospitals in Indonesia.Methods: We conducted a multicenter study with the retrospective design using data from patients undergoing open-heart surgery in 4 institutions in Indonesia. Data regarding LVEF and other potential risk factors were extracted from medical records and compiled in one datasheet. Statistical analyses were performed to assess if low LVEF was associated with postoperative mortality and identify other potential risk factors.Results: A total of 4789 patients underwent cardiac surgery in participating centers during the study period. Of these, 189 subjects (3.9%) had poor preoperative LVEF. Poor LVEF was associated with postoperative mortality (adjusted OR 2.761, 95% CI 1.763– 4.323, p < 0.001). Based on types of surgery, LVEF had a significant association with mortality only in CABG patients, while there was no such association in valve surgery and inconclusive in congenital surgery patients. Other significant independent predictors of in-hospital mortality included age more than 65 years old, non-elective surgery, the complexity of procedures, history of cardiac surgery, organ failure, CARE score ≥ 3, NYHA class ≥ III, and poor right ventricular function.Conclusion: Patients with low preoperative LVEF undergoing open-hear

Patrick Harnarayan, Dave Harnanan Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine, Trinidad & Tobago, West IndiesCorrespondence: Patrick Harnarayan, Department of Clinical Surgical Sciences, University of The West Indies, St. Augustine, Trinidad & Tobago, West Indies, Email patrick_harnarayan@hotmail.comAbstract: The Klippel-Trénaunay syndrome is an unusual syndrome of vascular and dermatologic manifestation in which patients demonstrate hemihypertrophy of the soft tissue and bones of one limb, cutaneous haemangiomas and varicosities in anatomically abnormal positions. Described in 1900 by two French physicians, the etiology remained unclear until recently, when evidence emerged that there was a genetic basis for this sporadic disorder. Genes that encoded pathological angiogenic factors and caused vascular dysmorphogenesis, explaining the molecular bases of this syndrome, were identified. Several angiogenic genes were identified but one gene, the AGGF1 (formerly VG5Q) gene, was seen in mutations involving patients diagnosed with Klippel-Trénaunay syndrome. Furthermore, this syndrome was also noted to have overlapping clinical features linked with the “overgrowth syndromes,” in which genetic mutations along somatic lines were identified. These involved The PI3K enzyme which forms part of the phosphoinositide 3–kinase pathway which is encoded by the PIK3CA-gene. This enzyme mediates embryonic cellular growth in-utero and diseases involved in this pathway are classified as members of the PIK3CA-related overgrowth syndrome. This paper reviews the status of what is now known about the molecular genetics of this unusual, but clinically challenging disorder and its differentiation from similar diseases, linked with the PIK3CA-gene and the related overgrowth syndromes.Keywords: Klippel-Trénaunay, mosaic transmission, PIK3CA-gene, limb-overgrowth spectrum

Jirar Topouchian,1 Parounak Zelveian,2 Zoya Hakobyan,2 Heghine Gharibyan,2 Roland Asmar3 1Diagnosis and Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 2Preventive Cardiology Dept, Institute of Cardiology Named After Levon Hovhannisyan, Yerevan, Armenia; 3Foundation-Medical Research Institutes (F-MRI)®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes ®, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: As recommended by various authorities and scientific societies, electronic devices for blood pressure (BP) measurements must undergo independent clinical validations for accuracy assessment.Objective: To assess the accuracy of the Withings BPM Connect device in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization “AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018)”.Methods: The Withings BPM Connect device measures BP at the brachial level using the oscillometric method. According to this protocol using the same-arm sequential BP measurement method, subjects (n ≥ 85) fulfilling the age, gender, BP and cuff distribution criteria must be included. Two criteria are used for the analysis: Criterion 1: differences between observers’ mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD) must be ≤ 5 ± 8 mmHg for both systolic (SBP) and diastolic BP (DBP). Criterion 2: the SD of the mean BP differences between the test device and reference BP per subject must be ≤ 6.91/6.62 mmHg for SBP/DBP.Results: Ninety-two subjects were selected, 85 of whom were included. For validation criterion 1, the mean difference ± SD between the reference and device BP values was 0.6 ± 5.3 mmHg for SBP and 2.1 ± 4.3 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the t

Oscar Plunde,1,2 Magnus Bäck1,2 1Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 2Department of Cardiology, Karolinska University Hospital, Stockholm, SwedenCorrespondence: Magnus Bäck, Department of Cardiology, Karolinska University Hospital, M85, Stockholm, 141 86, Sweden, Tel +46 8 585 800 00, Email magnus.back@ki.seAbstract: The most common cause for interventional valve treatment is aortic stenosis. A cardinal symptom of aortic stenosis is heart failure due to the increased load exerted on the left ventricle. However, the left ventricular load is not solely determined based on the degree of aortic stenosis but is also impacted by arterial stiffness. The combined load can be determined by valvulo-arterial impedance (Zva), which is associated with poor outcome in aortic stenosis. We recently demonstrated low measures of systemic arterial stiffness in patients with aortic stenosis, and that arterial stiffness was increased after surgical aortic valve replacement. The results indicated a masked arterial stiffness in aortic stenosis when using methods incorporating peripheral arterial segments. Available studies using several different methods to assess arterial stiffness in relatively small aortic stenosis cohorts examined before and after either surgical or transcatheter aortic valve replacement/intervention have generated contradictory results. In this commentary, we present a detailed literature review to explore how different methods and measures of arterial stiffness in aortic stenosis capture or not, a masked arterial stiffness in aortic stenosis and possible reasons for the observed results. Future studies validating a non-invasive reproducible method to assess arterial stiffness in aortic stenosis patients could potentially lead to an implementation in pre-interventional risk assessment for aortic stenosis.Keywords: aortic stenosis, arterial stiffness, pulse wave velocity, cardio ankle vascular index, valv

Manisha Kar Department of Physiology, AIIMS Bhubaneswar, Odisha, 751019, IndiaCorrespondence: Manisha Kar, Department of Physiology, AIIMS Bhubaneswar, Sijua, Patrapara, Bhubaneswar, Odisha, 751019, India, Tel +91 9438884009, Email physio_manisha@aiimsbhubaneswar.edu.inAbstract: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory coronavirus 2 (SARS-CoV2) has brought out changes in our daily life and has caused severe morbidity and mortality across the globe. Especially, post covid complications may remain a threat to the patient’s life. It may also increase the burden on existing health infrastructure and the country’s economy. This disease affects the respiratory system and other organ systems of the body, such as the cardiovascular system. The aim of the present narrative review is to understand how COVID-19 infection deranges vascular homeostasis, leading to endothelial dysfunction and arterial stiffness in the acute phase and following infection. To this effect, definite keywords were employed to obtain relevant information using PubMed database and Google Scholar search engines. It was documented that preexisting cardiovascular disease enhances morbidity in COVID-19 patients. Moreover, an elevated risk of development of new onset cardiovascular events has also been reported. Even a small amount of myocardial injury was significantly associated with death. The presence of virus in myocardial cells has also been documented. Furthermore, endothelial dysfunction and arterial stiffness were documented in the acute phase and 3– 4 weeks to 4 months after COVID infection. The virus enters endothelial cells by binding with ACE2 “receptor” on its surface and deranges cellular machinery. It results in reduced conversion of Ang II to Ang (1– 7). Accumulated Ang II then activates PI3K-Akt signaling pathway and regulates endothelial activation and production of IL-6 and reactive oxygen species (ROS). An imbalance between renin ang

Asaf Israeli,1 Danna Gal,1 Autba Younis,2 Scott Ehrenberg,1 Ehud Rozner,3 Yoav Turgeman,1,3 Edmund Naami,4 Robert Naami,5 Ofir Koren1,3 1Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; 2Internal Medicine E, Emek Medical Center, Afula, Israel; 3Heart Institute, Emek Medical Center, Afula, Israel; 4Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA; 5Department of Medicine, University Hospitals Cleveland Medical center, Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Ofir Koren, Heart Institute, Emek Medical Center, 21 Rabin Boulevard, Afula, 1834111, Israel, Tel +972-04-6495585, Email Drkorenofir@gmail.comBackground: Studies analyze the degree to which gender-based differences are affected by age and comorbidities show mixed results.Methods: Using a retrospective cohort study, we analyzed 327 consecutive patients who presented to the emergency department (ED) due to Atrial Fibrillation (AF) from 2014 to 2017 with follow-up at one year.Results: Females with AF were older (p < 0.001), with higher Body Mass Indexes (BMI) (p < 0.001), and a higher rate of hypertension (p < 0.001), hyperlipidemia (p = 0.01), diabetes mellitus (p = 0.05), valvular heart disease (p = 0.05), and thyroid dysfunction (18.3% vs 1.8%, p < 0.001). AF males had higher rate of coronary artery disease (p < 0.001) and heart failure with reduced ejection fraction (p < 0.001). Females were managed with rate control medications more frequently than with antiarrhythmic (p < 0.001). After adjusting gender to age and comorbidities, females continued to have higher rates of heart failure hospitalization (Odds Ratio (OR) 2.73 95% Confidence Interval (CI) 1.04– 5.89, P-value < 0.001) and recurrent AF (OR 3.86, P-value=0.02). Thyroid dysfunction and the lack of antiarrhythmic treatments significantly increased the risk of AF (OR 5.95 95% CI 3.15– 9.73, OR 3.42, respec

Bekalu Kebede, Tirsit Ketsela Clinical Pharmacy Unit, Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, EthiopiaCorrespondence: Bekalu Kebede, Department of Pharmacy, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia, Tel +251 921286140, Email bekalukebede19@gmail.comBackground: Venous thromboembolism is one of the major public health problems in the world. Though several studies were conducted to estimate common risk factors of venous thromboembolism and quality of anticoagulant therapy in Ethiopia, it is difficult to estimate the overall burdens of risk factors and quality of anticoagulant use because of the lack of a nationwide study.Objective: To assess magnitudes of risk factors of venous thromboembolism and quality of anticoagulant therapy in Ethiopia.Materials and Methods: Electronic searching using PubMed, EMBASE, Science Direct, Cochrane Database, Scopus, Hinari, Sci-Hub, African Journals Online Library, and Free-text Web Searches using Google Scholar was conducted from September, 15 to October 27, 2021. Each of the original studies was identified by Mesh terms and Boolean search technique using full title, various keywords and was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses.Results: The database search delivered a total of 2118 studies. After articles were removed by duplications, titles, reading the abstract, and assessed for eligibility criteria, 12 articles were found suitable for the systematic review. Prolonged immobilization (41.30%) was the most commonly observed risk factor of venous thrombosis followed by acute infection (40.25%). The proportion of therapeutic range (INR = 2– 3), sub-therapeutic range (INR < 2), and supra-therapeutic range (INR > 3) were 32.15%, 47.58%, and 17.62%, respectively. One hundred and thirty-eig

Ali Alhashim, Kawther Hadhiah, Hassan Al-Dandan, Mugbil Aljaman, Majed Alabdali, Mohammed Alshurem, Danah Aljaafari, Mustafa AlQarni Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi ArabiaCorrespondence: Ali Alhashim, Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia, Tel +966509444833, Email ahalhashem@iau.edu.saBackground: Spontaneous simultaneous bilateral basal ganglia hemorrhage (SSBBGH) is an extremely rare condition with only a few published case reports and series. However, there is no systematic review that has been published yet.Objective: The study aims to conduct a systematic review on spontaneous simultaneous bilateral basal ganglion bleeding and a descriptive statistical analysis of collected data on epidemiology, clinical features, etiology, therapeutic approach and prognosis. This review aims to be a clinical reference for busy clinicians when they are faced with such a rare condition.Methodology: This review has been carried out in accordance with recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.Results: Review of 60 cases showed that SSBBGH affected predominantly male patients (70%) with an average age of 50.8 ± 15.33 years and the male-to-female ratio was 2.5:1. The female patients tend to be older with an average age of 54.22 ± 16.67 years. Location of SSBBGHwas more common in the putamen (90% vs 10% non-putaminal). SSBBGH posed a significant mortality rate (33.33%). Among patients who survived, only 40.6% (13/32 report) have had favorable outcomes (mRS ≤ 2) and the remaining 59.4% (19/32) ended up with poor functional status (mRS ≥ 3-5). The most common implicated etiologies were hypertension followed by alcohol intoxication.Conclusion: SSBBGH is a rare clinical entity with significant morbidity and mortality. Systemic approach can lead to early recognition of etiol

Nicolas Postel-Vinay,1,2 Jiali-Delphine Shao,3 Anne Pinton,4 Aude Servais,5 Nicole Gebara,1 Laurence Amar1 1Hypertension Unit, ESH Excellence Center, Hôpital Européen Georges Pompidou, APHP, Paris, France; 2Hospital at Home, Fondation Santé Service, Levallois, France; 3Faculté de médecine de l’Université Paris Saclay, Le Kremlin Bicêtre, France; 4Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France; 5Nephrology and Transplantation Department, Necker Hospital, APHP, Paris, FranceCorrespondence: Nicolas Postel-Vinay, Email nicolas.postel-vinay@aphp.frIntroduction: Hy-Result is a rule management system designed to help patients to be compliant with the home blood pressure measurement (HBPM) monitoring schedule and to understand their BP readings. The aim of the Hy-Result e-Health prospective study is to evaluate the practice and experience of women using the Hy-Result coaching app for self-interpretation of BP readings during and after pregnancy.Methods: Participants were asked to: i) measure their BP at home; ii) use the Hy-Result app and send their PDF report to the researcher; iii) answer anonymously to 3 online independent questionnaires (Q).Results: A total of 107 women accepted to measure their BP and use the app. Among them 82 (77%) performed HBPM and used successfully the system and 72 (88%) shared to the investigator their PDF report by email. Of these, 95% declared the software was “easy” or “very easy” to use; 93% believe the software helps them to monitor their BP more effectively (74% agree, 18% somewhat agree); 94% that the color code classification was “clear”; 76 (93%) affirmed that the app helped them when consulting their physician for their BP evaluation. Majority (87%) perceived the software to be reliable. Furthermore, 71 (87%) said they trust the system and 51 (62%) declared that performing HBPM and self-interpret their readings was “reassuring” whereas 6 (7%) felt that it w

Håkan Bergh,1,2 Margit Albrektson,3 Clovis Kastberg,4 Amir Baigi,1,2 Lennart Hedström3 1School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 2Department of Research & Development Unit, Hospital Varberg, Region Halland, Sweden; 3Public Dental Services, Västra Vall, Varberg, Sweden; 4Tre Tandläkare, Varberg, SwedenCorrespondence: Håkan Bergh, School of Public Health and Community Medicine, Institute of Medicine, P.O. Box 463, Gothenburg, 405 30, Sweden, Email hakan.e.bergh@gmail.com Lennart Hedström, Public Dental Service, Västra Vallgatan 14, Varberg, S-43244, Region Halland, Sweden, Email h.lennart.hedstrom@gmail.comObjective: To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors.Methods: A total of 989 consecutive dental patients aged 55– 84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV).Results: Those with SV had more hypertension 41.8% vs 27.0% (p< 0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI − 7.73 &boxh; − 2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI − 0.42 &boxh; − 0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI − 4.66 &boxh; − 1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI − 0.03 &boxh; − 0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI − 1.11 &boxh; − 0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 &boxh;2.13), a

Fatima Ghaddar,1 Rouba K Zeidan,2– 5 Pascale Salameh,4,6– 8 Souzan Tatari,9 Guy Achkouty,10 Françoise Maupas-Schwalm11 1Doctoral School of Biology Health and Biotechnologies, Toulouse University, Toulouse, France; 2Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates; 3Faculty of Public Health II, Lebanese University, Mount-Lebanon, Lebanon; 4INSPECT-LB, National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon; 5CERIPH, Center for Research in Public Health, Faculty of Public Health, Lebanese University, Mount-Lebanon, Lebanon; 6Department of Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; 7Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; 8School of Medicine, Lebanese American University, Byblos, Lebanon; 9Cardiology department, Rafik Hariri University Hospital, Beirut, Lebanon; 10Cardiology Department, Mount Lebanon University Hospital, Mount-Lebanon, Lebanon; 11Faculty of Medicine, CHU Toulouse Rangueil, Toulouse, FranceCorrespondence: Fatima Ghaddar, Doctoral school of Biology Health and Biotechnologies, Toulouse University, Toulouse, France, Tel +32 470 53 71 52, Email fatmeghaddar90@gmail.comPurpose: Women are increasingly concerned by coronary heart disease (CHD), with peculiarities of their own, particularly concerning risk factors. The aim of the study was to assess the risk factors for CHD in Lebanese women over forty.Patients and Methods: A case–control study was carried out in 6 hospitals in Beirut and Mount-Lebanon, from December 2018 to December 2019 including 1500 patients (1200 controls and 300 cases). Women were stratified into pre- and post-menopausal groups. Personal and medical data were collected from hospital records and during an interview where validated questionnaires were used. Binary logistic regressions were performed to investigate potential predictors of CHD in the 2 groups.Results: I

Geraldine Poenou,1 Teona Dumitru Dumitru,1– 3 Ludovic Lafaie,4,5 Valentine Mismetti,5,6 Marco Heestermans,5,7 Laurent Bertoletti1,5,8 1Therapeutic and Vascular Medicine Department, University Hospital of Saint Etienne, Saint Etienne, France; 2Internal Medicine Department, University Hospital Santa Lucía, Cartagena, Murcia, Spain; 3Catholic University San Antonio, Murcia, Spain; 4Geriatric Department, University Hospital of Saint Etienne, Saint Etienne, France; 5INSERM, UMR1059, Haemostasis and Vascular Dysfunction Team, Jean Monnet University, Saint-Etienne, F-42055, France; 6Pneumology Department, University Hospital of Saint Etienne, Saint Etienne, France; 7Auvergne-Rhône-Alpes French Blood Donation Agency, Saint-Etienne, F-42100, France; 8INSERM, CIC-1408, University Hospital of Saint Etienne, Saint Etienne, FranceCorrespondence: Laurent Bertoletti, Therapeutic and Vascular Medicine Department, University Hospital of Saint Etienne, Saint Etienne, France, Tel +33477827771, Fax +33477820482, Email Laurent.bertoletti@gmail.comAbstract: During the past decade, emergence of direct oral anticoagulants (DOACs) has drastically improved the prevention of thrombosis. However, several unmet needs prevail in the field of thrombosis prevention, even in the DOACs’ era. The use of DOACs is still constrained and the drugs cannot be administered in every clinical scenario, such as an increased anticoagulant-associated bleeding risk, particularly in some specific populations (cancer – notably those with gastrointestinal or genitourinary cancer – and frail patients), the impossibility to be used in certain patients (eg, end-stage kidney failure during hemodialysis, pregnancy and breastfeeding), and their lack of efficacy in certain clinical scenarios (eg, mechanical heart valves, triple-positive antiphospholipid syndrome). Efforts to find a factor that upon antagonization prevents thrombosis but spares haemostasis have re

Sheran Li,1,2 Jacqueline K Phillips1 1Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; 2Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of ChinaCorrespondence: Sheran Li, Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Yuexiu District, Guangzhou, Guangdong Province, 510120, People’s Republic of China, Tel +86 20 81332723, Fax +86 20 8133 2650, Email lishr36@mail.sysu.edu.cnAbstract: Renal denervation (RDN) as a therapeutic intervention in patients with hypertension has been intensively studied for over a decade, yet a critical question remains unanswered: what kind of patients are the ideal target population for RDN to achieve its maximum clinical benefit? We herein provide a review of current literature to answer questions related to patient selection to identify populations that will benefit most from RDN, drawing first from human studies but also important clues derived from preclinical animal models. Different aspects that may influence the selection of patients such as the cause of hypertension, the severity of hypertension, concurrent pharmaceutical treatment, renal function, and renal artery anatomy are discussed. Based on current evidence, patients who have severe primary hypertension, regardless of medication or degree of renal dysfunction, who have an accessible accessory renal artery, can achieve a desirable response if a thorough ablation is achieved. In preclinical models, as in humans, RDN shows variable impact, with evidence indicating it does not work in specific conditions such as reduced renal mass, salt-sensitive hypertension, and autosomal recessive polycystic kidney disease. The thresholds, however, for indicators are such that it is still not possible to reliably predict which patients could benefit from the technique. Con

Cornelia Then,1,2 Chaterina Sujana,2– 4 Christian Herder,5– 7 Holger Then,8 Margit Heier,3,9 Christa Meisinger,10,11 Annette Peters,3,12 Wolfgang Koenig,12– 14 Wolfgang Rathmann,5,15 Haifa Maalmi,5,7 Katrin Ritzel,1 Michael Roden,5– 7 Michael Stumvoll,16 Barbara Thorand,2,3 Jochen Seissler1,2 1Department of Internal Medicine IV, University Hospital of Ludwigs-Maximilians-University Munich, Munich, Germany; 2German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Munich, Germany; 3Institute of Epidemiology, Helmholtz Zentrum Munich – German Research Center for Environmental Health (GmbH), Neuherberg, Germany; 4Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, Ludwigs-Maximilians-University Munich, Munich, Germany; 5German Center for Diabetes Research (DZD), Munich, Germany; 6Department of Endocrinology and Diabetology, Medical Faculty and University Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 7Institute of Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 8Freie Waldorfschule Augsburg, Augsburg, Germany; 9KORA Study Centre, University Hospital Augsburg, Augsburg, Germany; 10Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munich – German Research Center for Environmental Health (GmbH), Neuherberg, Germany; 11Chair of Epidemiology, University Hospital Augsburg, Augsburg, Germany; 12DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; 13Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; 14German Heart Center Munich, Technical University of Munich, Munich, Germany; 15Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 16Department of Medicine, University of Leipzig

Mei Ping Melody Koo, Hansraj Riteesh Bookun, Domenic Robinson Department of Vascular Surgery, St Vincent’s Hospital Melbourne, Melbourne, VIC, AustraliaCorrespondence: Mei Ping Melody Koo, Email melodykmp@gmail.comBackground: Secondary aortoenteric fistula is a rare, highly morbid and often difficult to diagnose, cause of gastrointestinal bleeding. It is associated with prior aortic surgery or placement of a synthetic aortic graft. Our case features staged hybrid endovascular stent-grafting, graft excision, aortoplasty using a bovine pericardial patch, extra-anatomical bypass and complex bowel repair.Case Report: An 82-year-old man presented with gastrointestinal bleeding and Streptococcus Anginosus bacteraemia, with previous aorto-bi-iliac bypass surgery for left common iliac occlusive disease 15 years ago. Computed tomography angiography (CTA), gastroscopy, colonoscopy, capsule endoscopy and enteroscopy identified no bleeding source. Repeat CTA showed gas locules and stranding around the graft and the third part of the duodenum, concerning for fistulous communication. On the next day, a Zenith TX2 thoracic 28x80mm stent-graft was deployed into the infrarenal aorta. On laparotomy, a fistula was present between the Dacron graft and fourth part of the duodenum. The Dacron graft was excised, followed by aortic patching with bovine pericardium. A right-to-left femoral-femoral crossover graft was constructed. CT at one-month post-laparotomy showed no signs of perigraft endoleak and interval resolution of gas locules. He was transferred to a rehabilitation facility on the 34th post-operative day with a multidisciplinary follow-up arranged.Discussion: Aortoduodenal fistula is a challenging entity to diagnose and should be suspected in patients with GI bleeding and prior aortic surgery. Endovascular repair alone is a less invasive option but with higher re-infection and late failure rates. Liberal use of appropriate imaging modalities, a judicious repair strategy