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Abstract Background Coaching in academic medicine may help learners develop lifelong learning skills. Studies typically evaluate the impact on coachees and program outcomes. Limited information is available about educating faculty to integrate the role of coaching. We explored a faculty coach training program at an academic medical center in the southern region of the United States. Methods Twenty faculty members in the college of medicine completed the 34-h training program meeting alternate weeks from May to November 2021. We collected data from reflections during training, a post-training survey, and three post-training focus group discussions making this a qualitatively driven mixed methods research. We used a transcendental phenomenological approach for the qualitative analysis entailing deriving essential meaning of the participants’ training experiences and perceptions about coaching. Results We identified 3 themes (1) perceptions, skills, and understanding of coaching, (2) perceived additional benefits from coach training, and (3) effective instructional practices to teach coaching. Under the first theme, participants expressed improved understanding about the process of coaching in academic medicine, noted the importance of listening to the whole person without judgment, questioning with curiosity, vulnerability, self-awareness, and reflection for building trust. Perceived additional benefits included personal development and illuminating discoveries. Sub-themes for effective instructional practices were learning community encompassing mindfulness, psychological safety, social cohesion, experiential and interactive learning, and suggestions. Faculty experienced internal transformation while learning coaching and felt they had the capacity to influence personal and professional development of learners and colleagues. The concepts reflection, awareness, growth, and relationship were threaded throughout the three themes. Conclusions The training evoked self-awareness and opportunities for personal growth. The newly trained coaches expressed the beginning of an internal transformation to embody being a coach and demonstrated willingness to influence personal and professional development of learners and colleagues. Effective instructional practices to teach coaching included mindfulness practice, psychological safety, social cohesion, and experiential and interactive learning. Based on these findings, it may be summarized that in the process of training to be a coach, the faculty not only recognized the benefits of coaching for learners but also realized individual personal benefits.

Introduction Mortality among pregnant women is a significant public health issue. Every day, approximately 830 women die worldwide due to complications during pregnancy or childbirth. Objective This retrospective descriptive study aims to determine the frequency, causes, and associated factors of maternal mortality in the health zone of Bunia in Ituri province. Materials and Methods This study employed the documentary method to examine various records, such as delivery registers, laboratory registers, and partographs of women who consulted the health facilities in the Bunia health zone for delivery during a specific period. The sample consisted of 61 maternal death records selected through multi-stage sampling from a total of 54,330 cases in the Bunia health zone, covering the period from January 1st, 2021 to August 31st, 2024. Data were encoded and analyzed using SPSS version 20, with the Chi-square test. Results The results show that the frequency of maternal deaths in the health zone was 0.11%. Hemorrhage was the leading cause of maternal death in the Bunia health zone, accounting for 45.95%. Delays in seeking medical care were the most significant factor associated with maternal deaths, representing 22.95%. Insufficient technical facilities were the most significant structural factor, representing 50.82%. Delays in care were the primary factor linked to midwives, at 67.21%. Conclusion In light of these results, it is essential to implement new contextual strategies to help combat and reduce maternal mortality rates.

Abstract Background Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. Methods The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers’ capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy’s effectiveness by comparing changes in patient (N = 240) and provider (N = 80–140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. Discussion This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women’s HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. Trial registration Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022

This work presents a study on the structure of a bronze mirror found in the Akterek burial complex by using neutron radiography and tomography. The manufacturing features and the physical state of this mirror was analyzed by three-dimensional model. It turned out that the rim on the edge was made of a different alloy, and the border between the rim and the base of the mirror is also visually visible. The morphological features and spatial distribution of pores and voids formed during secondary casting with the application of various patterns and ornaments have been studied in detail. The neutron tomography data made it possible to study the remains of a thin layer of corrosion on the surface of the mirror.

Catalytic transformation of light alkanes to aromatic compounds which are feedstocks to petrochemical industries is an important process. Here, a simple method of co-impregnation was employed to synthesize Zn-Cu/ZSM-5 for propane aromatization. Copper of varying loading 1–3 wt% was co-impregnated with zinc to improve zinc stability at the reaction condition. Catalyst physicochemical properties were analyzed using XRD, BET, N2-adsorption, FTIR, FTIR-Pyridine, SEM, TEM, H2-TPR and XPS. The XRD and FTIR characterization showed that the modified catalysts retained their crystallinity after metal impregnation with the XPS confirming the metal species having oxidation state of 2+. Hydrogen-TPR and XPS change in reduction temperature and binding energy spectra showed stronger intermetallic interaction respectively. Incorporation of Cu with Zn on ZSM-5 reduced Bronsted acidity from the FTIR-Pyridine while N2-adsorption isotherms verified the catalyst are microporous. The performance tests for propane aromatization over synthesized catalysts were carried out in a fixed bed reactor using GHSV of 1200 ml/g-h at 540 °C and atmospheric pressure. Co-impregnation of Zn with Cu improved the catalytic activity and sustained aromatic selectivity at an average of 85% for 12 h’ time on stream as compared to HZSM-5 (10%) and Zn/ZSM-5 (50%). Product distribution showed reduced light hydrocarbon formation and increased aromatic compounds with high selectivity towards toluene, m and o-xylene among the aromatic product distribution. The best aromatic selectivity product distribution was recorded for 2 wt% Cu with Zn, thus a more stable catalyst developed. XPS and H2-TPR analysis showed that the synergistic interaction between the two metals (Cu and Zn) improved the performance of bimetallic Zn-Cu/ZSM-5 catalyst by promoting zinc dispersion and stability during reaction.

The aromatization process of light alkanes is one of the major ways of adding value to the lower saturated hydrocarbons obtained from the refining process and Liquid Petroleum Gas, LPG. The thermodynamic analysis based on Gibbs free energy minimization subject to certain constraints was used to reduce the number of proposed species from thirty-six to thirteen at reaction conditions of 550 °C and 1 bar. The process of minimizing the Gibbs free energy equation was done using MATHCAD and Aspen Plus software in a carbon-free atmosphere. Influence of temperature (400 0C–1000 0C), pressure (1–10 bar), and flow rate (1 M of propane and molar fraction of products) was studied on product distribution in the form of selectivity, yield, and conversion of propane. It was observed that the formation of aromatics was least favored as seen from the yield at various temperatures. The hydrocarbon selectivity and yield were reported on a carbon basis. It was discovered that methane formation was most favored.The temperature which determines the maximum yield of the desired product was determined, yield and selectivity of aromatics were found to be independent of pressure at 1 to 10 bar, and m-xylene was found to be the most favored of the isomers of xylene. This work also presented the computational justification for assuming that isomers of products obtained from propane aromatization are in quasi-equilibrium.

INTRODUCTION: Patient waiting time is defined as the total amount of time spent within the healthcare facility outside of provider service or contact time. This has been evidenced in most healthcare facilities and becomes problematic if it exceeds thirty minutes. Most studies have shown that patients wait for two to four hours, resulting in their dissatisfaction and non-adherence to treatment plans. This study aimed to assess the waiting time and associated factors among outpatients at Kibungo Referral Hospital. METHOD: The quantitative research approach with the descriptive cross-sectional design was conducted for the outpatients received in September 2020 and 400 patients were considered. Convenience sampling technique and structured questionnaire were used for data collection. SPSS version 24 was used for data analysis and a p-value less than 0.05 was considered significant. Univariate, bivariate, and multivariate logistic regression were performed. Ethical principles were respected throughout the study. RESULTS: The median outpatient waiting time was 4hours. Female patients were 48% less likely to wait for a long time than men (AOR: 0.523, 95% CI: 0.294-0.931). However, patients who visited specialty units were 4 times more likely to wait for a longer time than those who visited allied health services (AOR: 4:246, CI: 1.463-12.316). In addition, patients who underwent paraclinical investigations were 18 times more likely to wait for a long time than others (AOR: 17.506, CI: 2.349-130.445). CONCLUSION: The median outpatient waiting time is long and the insufficient staffing, especially in specialty units and the laboratory, was evidenced to contribute to the long waiting time. Therefore, Kibungo Referral Hospital is recommended to increase staff in specialty units and paraclinical investigation departments.

Beans are one of the most popular and essential foods in Africa, especially in Nigeria they are highly recommended for its numerous health benefits and nutritional values. The objective of this paper is to assess the proximate and elemental compositions of three (3) varieties of beans (cowpea, kidney and sweet cowpea beans) marketed in Kawo, Kaduna State, Nigeria using standard procedures and atomic absorption spectroscopy (AAS). The results from this study indicated that the highest results obtained for proximate and elemental analysis in the four (4) samples with the exception of fibre in sweet cowpea beans (2.082%), were found to be: moisture (13.250%), protein (21.420%), Lipids (1.025%), ash (4.814%) in kidney beans while in the case of elemental analysis, the highest concentrations (88.0mg/kg) of Zn was found in (Cowpea bean), (52.5mg/kg) of Mg in sweet cowpea, (75.0mg/kg) of Cu in cowpea beans while Fe (99.5mg/kg) and Ca (99.5mg/kg) were found in kidney beans. All the beans samples analyzed for proximate and elemental analysis from Kawo market are highly nutritious, hence good for human and livestock consumption.

Существует множество исследований о связи независимости центральных банков и инфляции. Ряд авторов пришли к выводу, что существует их отрицательная связь, при которой независимость центрального банка способствует снижению инфляции. Но другие авторы подвергли этот вывод сомнению. В данном исследовании проверялась гипотеза о наличии отрицательной статистической связи между темпом инфляции и значениями индексов CWN и GMT независимости центрального банка, а также их составляющими подиндексами для развитых и постсоветских стран за 2001-2020 годы. Методами эконометрического и корреляционного анализа установлено отсутствие статистически значимого отрицательного влияния независимости центральных банков, измеряемой индексами CWN и GMT и их подиндексами, на инфляцию в развитых и постсоветских странах, верного в течение всего временного интервала. Графический анализ, а затем эконометрический анализ показал отсутствие отрицательной связи между этими индексами, а также их подиндексами, и инфляцией в отдельные годы как в развитых, так и в постсоветских странах. Более того, в некоторых случаях, наоборот, были выявлены их положи- тельные связи. Вместе с тем, на основе количественных оценок сделан вывод о том, что связь между независимостью центрального банка и инфляцией ослабевает по мере ее снижения. Он требует проверки и подтверждения в ходе дальнейших исследований. Ключевые слова: независимость центрального банка, инфляция, индексы CWN и GMT, раз- витые страны, постсоветские страны.

Relative isotopic yield distributions have been extracted for nine correlated fission fragment pairs following a detailed analysis of prompt γ−γ coincidence events from 232Th(α,f) reaction at Elab = 30 MeV. Simultaneously, the charge and mass yield distributions of the even-even fission fragments have been obtained from the measured relative isotopic yields. The onset of a triple-hump structure is seen in the extracted charge as well as mass yield distributions of the fragments. The results are consistent with the two-mode fission hypothesis of compound nucleus and in good agreement with the theoretical predictions, based on relevant fission models. The detailed results provide experimental evidence for the presence of two distinct compound nucleus fission modes, where the asymmetric and symmetric fission components are 83% and 17%, respectively. An average neutron multiplicity value of 4.60 ± 0.09 has been obtained, and the extracted neutron multiplicity distribution pattern corroborates the observed features of the multifaceted fission modes. Comparing the measured yield distributions following the 232Th(α,f) surrogate reaction, which produces 236U⁎ at an excitation energy of 21.5 MeV, with that of the direct reaction of 14 MeV neutron induced fission of 235U, an increase of about 11% in the yield of the symmetric component has been observed.

ZnO-ZnFe2O4 composite was applied for photocatalytic degradation of naphthalene in fresh and saline waters under visible light irradiation. The effects of initial concentration of naphthalene, ZnO-ZnFe2O4 dosage and salinity on photocatalytic degradation of naphthalene were investigated using the central composite design. Statistically significant model quadratic equation was developed for photocatalytic degradation of naphthalene using ZnO-ZnFe2O4 composite. The most significant parameter in the photocatalytic degradation is the ZnO-ZnFe2O4 dosage followed by the initial concentration of naphthalene and then salinity. The highest photocatalytic degradation of naphthalene was achieved at salinity of zero (that is in fresh water). The predicted optimum conditions for photocatalytic degradation of naphthalene using the ZnO-ZnFe2O4 composite are: initial naphthalene concentration of 16.8 mg/l, ZnO-ZnFe2O4 dosage of 0.50 g/l, and salinity of 0 ppt. The model quadratic equation was validated by performing experiments under the predicted optimum values. The experimental and the predicted values of naphthalene degradation under the predicted optimum values are 99.04 % and 98.8 %. Hence, the developed quadratic model is reliable for predicting photocatalytic degradation of naphthalene using ZnO-ZnFe2O4 composite.

В статье прослеживается путь трансформации экономики Казахстан за годы независимости и отмечены критические точки в ее развитии. Проведен анализ стадий, начиная с первых шагов в роли независимого государства до текущего периода пандемии. Он опирается на исследова- ния по Казахстану международных организаций, стратегические планы развития, послания Пре- зидента страны, а также статистические данные Бюро национальной статистики Агентства по стратегическому планированию и реформам Республики Казахстан. Указаны поворотные пункты в развитии страны: возобновление связей с бывшими союзными республиками, приток иностран- ных инвестиций и стремительный экономический рост в начале 2000-х годов, мировой финан- совый кризис 2008-2009 годов, углубление евразийской интеграции, резкое падение мировой цены на нефть в 2015-2016 годах, пандемия COVID-19. В статье сделан вывод, что поступле- ния от экспорта сырья обеспечивают рост экономики только в краткосрочном периоде, а для долгосрочного устойчивого роста необходима диверсификация экономики страны и экспорта, в частности развитие сектора услуг, развитие человеческого капитала и отраслей с высокой до- бавленной стоимостью. Также немаловажно повышение производительности базовых секторов экономики, таких как промышленность, сельское хозяйство, транспорт. Ключевые слова: экономический рост, экспорт, прямые иностранные инвестиции, государ- ственные программы, диверсификация, конкурентоспособность.

The competitiveness of the national economy is one of the most important economic concepts. There are many of its definitions and methods of measurement. Since the country’s competitiveness is formed by a huge number of factors, a literature review was carried out, as a result of which macroeconomic factors affecting the competitiveness of the economy were selected. The purpose of the article is to assess the degree of influence of selected factors on the global competitiveness of countries. For this, panel data of 60 countries for the period from 2006 to 2018 were collected. Based on this data, a regression analysis of panel data with fixed and random effects was carried out, where the dependent variable is the Global Competitiveness Index, and 22 macroeconomic factors act as independent variables. The Hausman test confirmed the preference for using a panel data model with fixed effects over a panel data model with random effects. As a result, 2 models were constructed that showed the degree of influence of the following factors to change the global competitiveness index: gross capital formation, total factor productivity, average labor productivity, pace of inflation rate, share of the current account balance in GDP, share of the employed population in the total population of the country, oil prices, growth rate of oil prices.

The phytochemical investigation of n-butanolic extract from the root bark of Ficus sycomorus using microwave-assisted extraction revealed the presence of steroids, triterpenes, flavonoids, alkaloids, and tannins. Detailed chromatographic techniques on the extract led to the isolation of a triterpenoid compound for the first time from the part of the plant, which was identified as lupeol acetate by chemical and spectroscopic studies. Antimicrobial activity study of the isolated compound on some selected microorganisms showed that the compound is a potential source of antibiotic agents. Keywords: Antimicrobial, Ficus sycomorus, lupeol acetate, root bark

The productive application of project management in the commercial sector gave impetus to the use of project management tools and performance of public authorities. The article is devoted to the description of the process of implementing project management in the system of public administration of the Republic of Kazakhstan. Experience in the use of project management in governmental bodies of the country has been studied. At the same time, the process of implementing project management in the authorities of the Russian Federation was analyzed to explore the experience of the near abroad. The experience of using the project management of Kazakhstan and the Russian Federation in carrying out large national projects such as EXPO-2017 and SOCHI-2014 has been studied.

The photovoltaics (PV) is a method of direct conversion of solar energy to electricity using semiconductor solar cells. In terms of globally installed capacity, PV remains third the most important renewable energy source after hydro and wind powers. 31.1 GW of PV systems were installed around the world in 2012 and up from 30.4 GW in 2011.There is a rapid growth of PV cell production and it is expected to increase further. However PV technology have to cost effective in comparison to hydro or wind powers and other sources of renewable energy. It has to reach the “grid parity” i.e. less or equal price for generated electricity power. More than 85% of solar cells (SC) are made from solar grade silicon (SoGSi). SoGSi is produced by purification of metallurgy grade silicon (MGSi) which is produced by carbon recovering silicon from quartz. Also Quartz is an initial and essential material for obtaining SoGSi and SC. Rich resource of quartz Sarykol located at southern part of Kazakhstan where the main factory for MG Si production «Каzsilicon» is situated. Upgrading of MGSi up to SoGSi consists is a number of technological steps and SoGSi is basis for PV industry. Therefore the cost of SoGSi determines the competitiveness of PV technology compared to other energy sources. There are several chemical and metallurgical technologies for SoGSi production. This paper briefly describes these technologies and shows main advantages of metallurgical technologies based on slag refining (oxygenation). Considered technologies are the basis for industrial production of SoGSi, solar cells with an efficiency of 15.8-17.1% and solar panels. The 1st power plant made from solar panels in Kazakhstan was launched in December 25, 2012 by «AstanaSolar» with a total capacity of 250 kW.

Background/Objectives. The aim of this study was to evaluate oxidant and antioxidant status in children with different grades of Protein Energy Malnutrition (PEM). Subjects/Methods. A total of two hundred fifty (250) children (age range: 6 months to 5 years) living in eastern UP, India, were recruited. One hundred and ninety-three (193) of these children had different grades of PEM (sixty-five (65) children belong to mild, sixty (60) to moderate, and sixty-eight (68) to severe group). Grading in group was done after standardization in weight and height measurements. Fifty-seven (57) children who are age and and sex matched, healthy, and well-nourished were recruited from the local community and used as controls after checking their protein status (clinical nutritional status) with height and weight standardization. Redox homeostasis was assessed using spectrophotometric/colorimetric methods. Results. In our study, erythrocyte glutathione (GSH), plasma Cu, Zn-superoxide dismutase (Cu,Zn-SOD,EC 1.15.1.1), ceruloplasmin (Cp), and ascorbic acid were significantly (P

In the present study, we consider a nutrient-autotroph-herbivore ecosystem model where the herbivore species is assumed to have a commercial value. We use a Holling type-II harvest function to model density dependent herbivore harvesting. Stability criteria of the resulting model is investigated both from analytical and numerical viewpoints. The investigation revealed the existence of a number of threshold values of the harvest rate that have a remarkable influence on the system dynamics. Next we incorporate a noise term in the parameter representing harvest rate to model the phenomenon of poaching as random harvesting. The stochastic model is analyzed for exponential mean square stability and the resulting criteria in terms of harvest related parameters obtained. These parameter thresholds could be utilized to develop effective harvesting strategies and wildlife management policies which take into account the overall survival of the ecological populations.

Salmonella are a rare cause of toe abscess. We report a case of Salmonella typhimurium in sickle cell anemia in a pediatric patient. The isolate was sensitive to commonly used antibiotics and the patient was treated successfully with a course of amoxicillin.

(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88-1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75-1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72-1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock ( p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40-0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.

Aims: The aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1 year follow-up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic., Methods and Results: The study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1 year follow-up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1 year follow-up in relation to time since diagnosis of HFrEF in patients diagnosed within 3 months, between 3 months and 1 year, and beyond 1 year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1 year follow-up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01-2.96; P < 0.05], non-ischaemic aetiology (OR: 1.95; 95% CI: 1.15-3.30; P < 0.05), and left ventricular end-diastolic diameter (LVEDD) <60 mm (OR: 2.04; 95% CI: 1.18-3.51; P < 0.05). The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The incidence of HFimpEF was 27.1% in patients diagnosed within 3 months, 18.4% in patients diagnosed between 3 months and 1 year, and 12.2% in patients diagnosed beyond 1 year. Non-ischaemic aetiology (OR: 4.76; 95% CI: 1.83-12.4; P < 0.01) and QRS width (OR: 0.81; 95% CI: 0.71-0.94; P < 0.01) for patients diagnosed within 3 months, LVEDD (OR: 0.54; 95% CI: 0.32-0.90; P < 0.05) and left atrial diameter ≤45 mm (OR: 5.44; 95% CI: 1.45-20.4; P < 0.05) for patients diagnosed between 3 months and 1 year, and LVEDD < 67 mm (OR: 2.71; 95% CI: 1.07-6.88; P < 0.05) for patients diagnosed beyond 1 year were found to be independent predictive factors., Conclusions: In our study, in this HFrEF patient population managed in a heart failure outpatient clinic, the 1 year incidence of HFimpEF was found to be ~20%. The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The most important predictors of the development of HFimpEF were female sex, non-ischaemic aetiology, narrower QRS width, and smaller diameter of the left ventricle and left atrium., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Kidney dysfunction (KD) is a main limiting factor of applying guideline-directed medical therapy (GDMT) and reaching the recommended target doses (TD) in heart failure (HF) with reduced ejection fraction (HFrEF)., Hypothesis: We aimed to assess the success of optimization, long-term applicability, and adherence of neurohormonal antagonist triple therapy (TT:RASi [ACEi/ARB/ARNI] + βB + MRA) according to the KD after a HF hospitalization and to investigate its impact on prognosis., Methods: The data of 247 real-world, consecutive patients were analyzed who were hospitalized in 2019-2021 for HFrEF and then were followed-up for 1 year. The application and the ratio of reached TD of TT at hospital discharge and at 1 year were assessed comparing KD categories (eGFR: ≥90, 60-89, 45-59, 30-44, <30 mL/min/1.73 m 2 ). Moreover, 1-year all-cause mortality and rehospitalization rates in KD subgroups were investigated., Results: Majority of the patients received TT at hospital discharge (77%) and at 1 year (73%). More severe KD led to a lower application ratio (p < .05) of TT (92%, 88%, 80%, 73%, 31%) at discharge and at 1 year (81%, 76%, 76%, 68%, 40%). Patients with more severe KD were less likely (p < .05) to receive TD of MRA (81%, 68%, 78%, 61%, 52%) at discharge and a RASi (53%, 49%, 45%, 21%, 27%) at 1 year. One-year all-cause mortality (14%, 15%, 16%, 33%, 48%, p < .001), the ratio of all-cause rehospitalizations (30%, 35%, 40%, 43%, 52%, p = .028), and rehospitalizations for HF (8%, 13%, 18%, 20%, 38%, p = .001) were significantly higher in more severe KD categories., Conclusions: KD unfavorably affects the application of TT in HFrEF, however poorer mortality and rehospitalization rates among them highlight the role of the conscious implementation and up-titration of GDMT., (© 2024 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.)

(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher ( p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401-0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.

Introduction: Renal dysfunction is a main limiting factor of applying and up-titrating guideline-directed medical therapy (GDMT) among patients with heart failure with reduced ejection fraction (HFrEF)., Objective: Our retrospective monocentric observational study aimed to analyse the application ratio of combined neurohormonal antagonist therapy (RASi: ACEI/ARB/ARNI + βB + MRA) and 12-month all-cause mortality differences in terms of renal dysfunction among HFrEF patients hospitalized for heart failure., Method: We retrospectively analysed the cohort of consecutive HFrEF patients, hospitalized at the Heart Failure Unit of our tertiary cardiological centre in 2019-2021. The application ratio of discharge triple therapy (TT) in five groups established on admission eGFR parameters, representing severity of renal dysfunction (eGFR≥90, eGFR = 60-89, eGFR = 45-59, eGFR = 30-44, eGFR<30 ml/min/1.73 m2) was investigated with chi-square test, while 12-month mortality differences were analysed with Kaplan-Meier method and log-rank test., Results: 257 patients were included. Median eGFR was 57 (39-75) ml/min/1.73 m2, 54% of patients had eGFR<60 ml/min/1.73 m2. The proportion of patients in eGFR≥90, 60-89, 45-59, 30-44, <30 ml/min/1.73 m2 subgroups was 12%, 34%, 18%, 21%, 15%, respectively. 2% of patients were on dialysis. Even though the application rate of TT was notably high (77%) in the total cohort, more severe renal dysfunction led to a significantly lower implementation rate of TT (94%, 86%, 91%, 70%, 34%; p<0.0001): the application rate of RASi (100%, 98%, 96%, 89%, 50%, p<0.0001), βB (94%, 88%, 96%, 79%, 68%; p = 0.003) and MRA therapy (97%, 99%, 98%, 94%, 82%; p = 0.001) differed significantly. 12-month all-cause mortality was 23% in the whole cohort. Mortality rates were higher in more severe renal dysfunction (3%, 15%, 22%, 31%, 46%; p<0.0001)., Conclusion: Even though the proportion of patients on TT in the whole cohort was remarkably high, renal dysfunction led to a significantly lower application ratio of TT, associating with worse survival. Our results highlight that despite renal dysfunction the application of HFrEF cornerstone pharmacotherapy is essential. Orv Hetil. 2023; 164(35): 1387-1396.

Introduction: Hospitalization due to heart failure (HF) progression is associated with poor prognosis. This highlights the role of the implementation of guideline-directed medical therapy (GDMT) in improving the morbidity and mortality of patients with heart failure with reduced ejection fraction (HFrEF). There are limited data about the intrahospital applicability of GDMT in real-world circumstances. We aimed to assess retrospectively the use of cornerstone GDMT including RASi (ACEI/ARB/ARNI), βB, MRA, and SGLT2i treatment in a consecutive real-world HFrEF patient population admitted with signs and symptoms of HF to the HF Unit of a Hungarian tertiary cardiac center between 2019 and 2021. The independent predictors of therapy optimization and the applicability of new HFrEF medication (ARNI, SGLT2i, vericiguat) were also investigated., Methods: Statistical comparison of admission and discharge medication was accomplished with Fisher's exact test. The independent predictors of the introduction of triple therapy (RASi + βB + MRA) were analyzed using univariate and multivariate logistic regression. The proportion of patients eligible for vericiguat based on the inclusion and exclusion criteria of the VICTORIA trial was also investigated, as well as the number of patients suitable for ARNI and SGLT2i, taking into account the contraindications of application contained in the ESC 2021 HF Guidelines., Results: 238 patients were included. During hospitalization, the use of RASi (69% vs. 89%) (ACEI/ARBs [58% vs. 70%], ARNI [10% vs. 19%]), βBs (69% vs. 85%), and MRAs (61% vs. 95%) increased significantly (p < 0.05) compared to at admission, and the use of SGLT2i (3% vs. 11%) also rose (p = 0.0005). The application ratio of triple (RASi + βB + MRA; 43% vs. 77%) and quadruple (RASi + βB + MRA + SGLT2i; 2% vs. 11%) therapy increased as well (p < 0.0001). The independent predictors of discharge application of triple therapy revealed through multivariate logistic regression analysis were age, duration of hospitalization, eGFR, NTproBNP, and presence of diabetes mellitus. Sixty-eight percent of the cohort would have been suitable for vericiguat, 83% for ARNI, and 84% for SGLT2i., Conclusion: High rates of application of disease-modifying drugs are achievable among hospitalized HFrEF patients in severe clinical condition; thus, awareness of the need for their initiation must be raised., (© 2022 S. Karger AG, Basel.)

Background: Variant transthyretin amyloidosis (ATTRv) is an autosomal dominant inherited disease, where the mutation of the transthyretin gene (TTR) results in the deposition of pathogenic protein fibrils in various tissues. The mutation type influences the clinical course. Until now, no data were available on the genotype, phenotype, and prevalence of Hungarian ATTRv patients. The aim of our study was to assess the prevalence, regional distribution, genotypes, and phenotypes of Hungarian patients with ATTRv., Methods: With the collaboration of Hungarian regional and university centers, we identified patients diagnosed with ATTRv. We also searched prior publications for case studies of Hungarian ATTRv patients., Results: 40 individuals in 23 families with ATTRv were identified within the borders of Hungary. At the time of the diagnosis, 24 of them were symptomatic. The two most common mutations were ATTRHis88Arg (nine families) and ATTRIle107Val (8 families). ATTRVal30Met was demonstrated in 2 families, and ATTRVal122del, ATTRPhe33Leu, ATTRIle84Ser, and ATTRAsp18Gly in one family each. The median age of the symptomatic patients at the time of clinical diagnosis was 65 years. The most common clinically significant organ involvement was restrictive cardiomyopathy, found in 24 patients. Polyneuropathy was diagnosed in 20 patients. A total of 19 patients showed a mixed phenotype. The leading symptom was heart failure in 8 cases (3 of them had only cardiac symptoms), polyneuropathy in 11 cases (all of them also had cardiac symptoms), and equally severe cardiac and neuropathy symptoms were present in 3 cases. Out of 24 symptomatic patients, 10 received targeted pharmacological therapy. The follow-up period ranged from 1 to 195 months. At the time of the retrospective analysis, 12 patients had already died, and 1 patient underwent heart transplantation., Conclusions: As TTR genotype influences the phenotype and clinical course of ATTRv, it is important to know the regional data. In Hungary, ATTRHis88Arg and ATTRIle107Val are the most common mutations in ATTRv, both presenting with mixed phenotype, but the median age at the time of the diagnosis is 9 years lower in patients with ATTRHis88Arg than in patients with ATTRIle107Val.

Introduction: Based on recently published randomized controlled trials, cardiac contractility modulation (CCM) seems to be an effective device-based therapeutic option in symptomatic chronic heart failure (HF) (CHF). The aim of the current study was to estimate what proportion of patients with CHF and left ventricular ejection fraction (LVEF) <50% could be eligible for CCM based on the inclusion criteria of the FIX-HF-5C trial., Methods: Consecutive patients referred and followed up at our HF clinic due to HF with reduced or mid-range LVEF were retrospectively assessed. After a treatment optimization period of 3-6 months, the inclusion criteria of the FIX-HF-5C trial (New York Heart Association (NYHA) class III/IV, 25% ≤ LVEF ≤45%, QRS <130 ms, and sinus rhythm) were applied to determine the number of patients eligible for CCM., Results: Of the 640 patients who were involved, the proportion of highly symptomatic patients in NYHA class III/IV decreased from 77.0% (n = 493) at baseline to 18.6% (n = 119) after the treatment optimization period (p < 0.001). Mean LVEF increased significantly from 29.0 ± 7.9% to 36.3 ± 9.9% (p < 0.001), while the proportion of patients with 25% ≤ LVEF ≤45% increased from 69.7% (n = 446) to 73.3% (n = 469) (p < 0.001). QRS duration was below 130 ms in 63.1% of patients, while 30.0% of patients had persistent or permanent atrial fibrillation. We found that the eligibility criteria for CCM therapy based on the FIX-HF-5C study were fulfilled for 23.0% (n = 147) of patients at baseline and 5.2% (n = 33) after treatment optimization., Conclusion: This single-center cohort study showed that 5% of patients with CHF and impaired LVEF immediately after treatment optimization fulfilled the inclusion criteria of the FIX-HF-5C study and would be candidates for CCM., (© 2021 S. Karger AG, Basel.)

Background: Recently published studies suggested that digoxin may increase mortality in heart failure with reduced ejection fraction (HFrEF). However, in the vast majority of former trials serum digoxin concentration (SDC) was not measured and therapy was not SDC-guided., Aim: To assess the impact of SDC-guided digoxin therapy on mortality in HFrEF patients., Methods: Data of 580 HFrEF patients were retrospectively analyzed. In patients on digoxin, SDC was measured every 3 months and digoxin dosage was SDC-guided (target SDC: 0.5-0.9 ng/mL). All-cause mortality of digoxin users and nonusers was compared after propensity score matching (PSM)., Results: After 7.1 ± 4.7 years follow-up period (FUP) all-cause mortality of digoxin users (n = 180) was significantly higher than nonusers (n = 297) (propensity-adjusted HR = 1.430; 95% CI = 1.134-1.804; P = .003). Patients having SDC of 0.9 to 1.1 ng/mL (n = 60) or > 1.1 ng/mL (n = 44) at any time during the FUP had an increased risk of all-cause mortality (HR = 1.750; 95% CI = 1.257-2.436, P = .001 and HR = 1.687; 95% CI = 1.153-2.466, P = .007), while patients having a maximal SDC < 0.9 ng/mL (n = 76) had similar mortality risk (HR = 1.139; 95% CI = 0.827-1.570, P = .426), compared to digoxin nonusers., Conclusions: According to our propensity-matched analysis, SDC-guided digoxin therapy was associated with increased all-cause mortality in optimally treated HFrEF patients, especially with SDC ≥0.9 ng/mL. These results reinforce the expert opinion that digoxin in HFrEF can only be used among carefully selected patients with close SDC monitoring., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Ischaemic cardiomyopathy (ICM) represents an important cardiovascular condition associated with substantially increased morbidity and mortality. It is characterised from a broad spectrum of clinical manifestations and pathophysiological substrates and its diagnosis is based on the demonstration of significant left ventricular dysfunction in the context of significant epicardial coronary artery disease. Contemporary management aims at improving prognosis through evidence-based pharmacotherapy and device therapy, where indicated. Whilst the beneficial role of revascularisation remains clear in patients with strong indications such as those with symptoms and/or acute coronary syndromes, for those patients that are asymptomatic and suffer from stable ischaemic heart disease the impact of revascularisation on hard outcomes remains less well defined and currently its adoption is hampered by the lack of robust randomised data. The aim of this review is therefore to provide a constructive appraisal on the pathophysiology of ICM, the role of the various non-invasive imaging techniques in the diagnosis of ICM and the differentiation between viable and non-viable myocardium and finally discourse the potential role of revascularisation and contemporary device therapy in the management of patients with ICM., (© 2020 European Society of Cardiology.)

Objective: Patients with electrical injury are considered to be at high risk of cardiac arrhythmias. Due to the small number of studies, there is no widely accepted guideline regarding the risk assessment and management of arrhythmic complications after electrical accident (EA). Our retrospective observational study was designed to determine the prevalence of ECG abnormalities and cardiac arrhythmias after EA, to evaluate the predictive value of cardiac biomarkers for this condition and to assess in-hospital and 30-day mortality., Methods: Consecutive patients presenting after EA at the emergency department of our institution between 2011 and 2016 were involved in the current analysis. ECG abnormalities and arrhythmias were analyzed at admission and during ECG monitoring. Levels of cardiac troponin I, CK and CK-MB were also collected. In-hospital and 30-day mortality data were obtained from hospital records and from the national insurance database., Results: Of the 480 patients included, 184 (38.3%) had suffered a workplace accident. The majority of patients (96.2%) had incurred a low-voltage injury (< 1000 V). One hundred and four (21.7%) patients had a transthoracic electrical injury while 13 (2.7%) patients reported loss of consciousness. The most frequent ECG disorders at admission were sinus bradycardia (< 60 bpm, n = 50, 10.4%) and sinus tachycardia (> 100 bpm, n = 21, 4.4%). Other detected arrhythmias were as follows: newly diagnosed atrial fibrillation (n = 1); frequent multifocal atrial premature complexes (n = 1); sinus arrest with atrial escape rhythm (n = 2); ventricular fibrillation terminated out of hospital (n = 1); ventricular bigeminy (n = 1); and repetitive nonsustained ventricular tachycardia (n = 1). ECG monitoring was performed in 182 (37.9%) patients for 12.7 ± 7.1 h at the ED. Except for one case with regular supraventricular tachycardia terminated via vagal maneuver and one other case with paroxysmal atrial fibrillation, no clinically relevant arrhythmias were detected during the ECG monitoring. Cardiac troponin I was measured in 354 (73.8%) cases at 4.6 ± 4.3 h after the EA and was significantly elevated only in one resuscitated patient. CK elevation was frequent, but CK-MB was under 5% in all patients. Both in-hospital and 30-day mortality were 0%., Conclusions: Most of cardiac arrhythmias in patients presenting after EA can be diagnosed by an ECG on admission, thus routine ECG monitoring appears to be unnecessary. In our patient cohort cardiac troponin I and CK-MB were not useful in risk assessment after EA. Late-onset malignant arrhythmias were not observed.

Background: Remote monitoring is an established, guideline-recommended technology with unequivocal clinical benefits; however, its ability to improve survival is contradictory., Objective: The aim of our study was to investigate the effects of remote monitoring on mortality in an optimally treated heart failure patient population undergoing cardiac resynchronization defibrillator therapy (CRT-D) implantation in a large-volume tertiary referral center., Methods: The population of this single-center, retrospective, observational study included 231 consecutive patients receiving CRT-D devices in the Medical Centre of the Hungarian Defence Forces (Budapest, Hungary) from January 2011 to June 2016. Clinical outcomes were compared between patients on remote monitoring and conventional follow-up., Results: The mean follow-up time was 28.4 (SD 18.1) months. Patients on remote monitoring were more likely to have atrial fibrillation, received heart failure management at our dedicated heart failure outpatient clinic more often, and have a slightly lower functional capacity. Crude all-cause mortality of remote-monitored patients was significantly lower compared with patients followed conventionally (hazard ratio [HR] 0.368, 95% CI 0.186-0.727, P=.004). The survival benefit remained statistically significant after adjustment for important baseline parameters (adjusted HR 0.361, 95% CI 0.181-0.722, P=.004)., Conclusions: In this single-center, retrospective study of optimally treated heart failure patients undergoing CRT-D implantation, the use of remote monitoring systems was associated with a significantly better survival rate., (©Peter Bogyi, Mate Vamos, Zsolt Bari, Balazs Polgar, Balazs Muk, Noemi Nyolczas, Robert Gabor Kiss, Gabor Zoltan Duray. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.07.2019.)

Background: The reliability of intrathoracic impedance monitoring for prediction of heart failure (HF) by implantable cardiac devices is controversial. Despite using additional device-based parameters described in the PARTNERS HF study, such as new onset of arrhythmias, abnormal autonomics, low biventricular pacing rate or patient activity level, the predictive power of device diagnostic algorithm is still in doubt. The objective of this study was to compare the device diagnostic algorithm described in the PARTNERS HF study to a newly developed algorithm applying refined diagnostic criteria., Methods: Fourty two patients were prospectively enrolled who had been implanted with an intrathoracic impedance and remote monitoring capable implantable cardiac defibrillator with a cardiac resychroniza-tion therapy (CRT-D) device in this observational study. If a remote OptiVolTM alert occurred, patients were checked for presence of HF symptoms. A new algorithm was derived from the original PARTNERS HF criteria, considering more sensitive cut-offs and changes of patterns of the device-based parameters., Results: During an average follow-up of 38 months, 722 remote transmissions were received. From the total of 128 transmissions with OptiVol alerts, 32 (25%) corresponded to true HF events. Upon multivariate discriminant analysis, low patient activity, high nocturnal heart rate, and low CRT pacing (< 90%) proved to be independent predictors of true HF events (all p < 0.01). Incorporating these three refined criteria in a new algorithm, the diagnostic yield of OptiVol was improved by increasing specific-ity from 37.5% to 86.5%, positive predictive value from 34.1% to 69.8% and area under the curve from 0.787 to 0.922 (p < 0.01), without a relevant loss in sensitivity (96.9% vs. 93.8%)., Conclusions: A refined device diagnostic algorithm based on the parameters of low activity level, high nocturnal heart rate, and suboptimal biventricular pacing might improve the clinical reliability of OptiVol alerts.

The use of direct acting vasodilators (the combination of hydralazine and isosorbide dinitrate -Hy+ISDN-) in heart failure with reduced ejection fraction (HFrEF) is supported by evidence, but rarely used.However, treatment with Hy+ISDN is guideline-recommended for HFrEF patients who cannot receive either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers due to intolerance or contraindication, and in self-identified African-American HFrEF patients who are symptomatic despite optimal neurohumoral therapy.The Hy+ISDN combination has arterial and venous vasodilating properties. It can decrease preload and afterload, decrease left ventricular end-diastolic diameter and the volume of mitral regurgitation, reduce left atrial and left ventricular wall tension, decrease pulmonary artery pressure and pulmonary arterial wedge pressure, increase stroke volume, and improve left ventricular ejection fraction, as well as induce left ventricular reverse remodelling. Furthermore, Hy+ISDN combination has antioxidant property, it affects endothelial dysfunction beneficially and improves NO bioavailability. Because of these benefits, this combination can improve the signs and symptoms of heart failure, exercise capacity and quality of life, and, most importantly, reduce morbidity and mortality in well-defined subgroups of HFrEF patients.Accordingly, this therapeutic option can in many cases play an essential role in the treatment of HFrEF.