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Abstract Background Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) present a decrease in functional capacity due to the intrinsic nature of both pathologies. It is not known about the potential impact of T2DM on functional capacity when assessed by 6-min step test (6MST) and its effect as a prognostic marker for fatal and non-fatal events in patients with CHF. Objective to evaluate the coexistence of T2DM and CHF in functional capacity through 6MST when compared to CHF non-T2DM, as well as to investigate the different cardiovascular responses to 6MST and the risk of mortality, decompensation of CHF and acute myocardial infarction (AMI) over 36 months. Methods This is a prospective cohort study with 36 months of follow-up in individuals with T2DM and CHF. All participants completed a clinical assessment, followed by pulmonary function testing, echocardiography, and 6MST. The 6MST was performed on a 20 cm high step and cardiovascular responses were collected: heart rate, systemic blood pressure, oxygen saturation, BORG dyspnea and fatigue. The risk of mortality, acute myocardial infarction and decompensation of CHF was evaluated. Results Eighty-six participants were included. The CHF-T2DM group had a significantly lower functional capacity than the CHF non-T2DM group (p 0.05). Conclusion T2DM negatively affects the functional performance of 6MST in patients with CHF. Gender, ejection fraction (%), FEV1 (L) and T2DM itself negatively influence exercise performance.

Background: Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) present a decrease in functional capacity due to the intrinsic nature of both pathologies. It is not known about the potential impact of T2DM on functional capacity when assessed by 6-min step test (6MST) and its effect as a prognostic marker for fatal and non-fatal events in patients with CHF. Objective: to evaluate the coexistence of T2DM and CHF in functional capacity through 6MST when compared to CHF non-T2DM, as well as to investigate the different cardiovascular responses to 6MST and the risk of mortality, decompensation of CHF and acute myocardial infarction (AMI) over 36 months. Methods: This is a prospective cohort study with 36 months of follow-up in individuals with T2DM and CHF. All participants completed a clinical assessment, followed by pulmonary function testing, echocardiography, and 6MST. The 6MST was performed on a 20 cm high step and cardiovascular responses were collected: heart rate, systemic blood pressure, oxygen saturation, BORG dyspnea and fatigue. The risk of mortality, acute myocardial infarction and decompensation of CHF was evaluated. Results: Eighty-six participants were included. The CHF-T2DM group had a significantly lower functional capacity than the CHF non-T2DM group (p < 0.05). Forced Expiratory Volume in one second (L), ejection fraction (%), gender and T2DM influence and are predictors of functional capacity (p < 0.05; adjusted R squared: 0.419). CHF-T2DM group presented a higher risk of mortality and acute myocardial infarction over the 36 months of follow-up (p < 0.05), but not to the risk of decompensation (p > 0.05). Conclusion: T2DM negatively affects the functional performance of 6MST in patients with CHF. Gender, ejection fraction (%), FEV1 (L) and T2DM itself negatively influence exercise performance. [ABSTRACT FROM AUTHOR]

Chronic heart disease (CHD) is a widespread and persistent health challenge that demands immediate attention. Early detection and accurate diagnosis are essential for effective treatment and management of this condition. To overcome this difficulty, we created a state-of-the-art IoT-Based Ambulatory Blood Pressure Monitoring System that provides real-time blood pressure readings, systolic, diastolic, and pulse rates at predefined intervals. This unique technology comes with a module that forecasts CHD's early warning score. Various machine learning algorithms employed comprise Naïve Bayes, K-Nearest Neighbors (K-NN), random forest, decision tree, and Support Vector Machine (SVM). Using Naïve Bayes, the proposed model has achieved an impressive 99.44% accuracy in predicting blood pressure, a vital aspect of real-time intensive care for CHD. This IoT-based ambulatory blood pressure monitoring (IABPM) system will provide some advancement in the field of healthcare. The system overcomes the limitations of earlier BP monitoring devices, significantly reduces healthcare costs, and efficiently detects irregularities in chronic heart diseases. By implementing this system, we can take a significant step forward in improving patient outcomes and reducing the global burden of CHD. The system's advanced features provide an accurate and reliable diagnosis that is essential for treating and managing CHD. Overall, this IoT-based ambulatory blood pressure monitoring system is an important tool for the early identification and treatment of CHD in the field of healthcare. [ABSTRACT FROM AUTHOR]

This study aimed to describe pneumococcal polysaccharide vaccine-23 (PPSV23) vaccination use in high-risk pediatric patients with chronic heart disease (CHD). This was a single-center retrospective cohort study. Patients were included if they were aged 2–18 years and were diagnosed with CHD. The primary outcome was PPSV23 vaccination. Secondary outcomes included missed opportunities and the incidence of infections. Three hundred ninety-two patients were included; the mean age was 8.8 years. Only 40 patients (10.2%) had documentation of PPSV23 vaccination. Patients had a median number of three clinic visits in 2019. There were 114 cases of pneumonia documented in patients before receiving PPSV23 and one case reported after PPSV23 vaccination. PPSV23 vaccination in high-risk pediatric patients with CHD was low, with many documented missed opportunities for vaccination. This may be attributed to the PPSV23 not being a routine vaccination on the pediatric schedule. [ABSTRACT FROM AUTHOR]

Introduction: YiYiFuZi powder (YYFZ) is a classical formula in Chinese medicine, which is commonly used clinically for the treatment of Chronic Heart Disease (CHD), but it’s pharmacological effects and mechanism of action are currently unclear.Methods: An adriamycin-induced CHD model rat was established to evaluate the pharmacological effects of YYFZ on CHD by the results of inflammatory factor level, histopathology and echocardiography. Metabolomic studies were performed on rat plasma using UPLC-Q-TOF/MS to screen biomarkers and enrich metabolic pathways; network pharmacology analysis was also performed to obtain the potential targets and pathways of YYFZ for the treatment of CHD.Results: The results showed that YYFZ significantly reduced the levels of TNF-α and BNP in the serum of rats, alleviated the disorder of cardiomyocyte arrangement and inflammatory cell infiltration, and improved the cardiac function of rats with CHD. The metabolomic analysis identified a total of 19 metabolites, related to amino acid metabolism, fatty acid metabolism, and other metabolic pathways. Network pharmacology showed that YYFZ acts through PI3K/Akt signaling pathway, MAPK signaling pathway and Ras signaling pathway.Discussion: YYFZ treatment of CHD modulates blood metabolic pattern and several protein phosphorylation cascades but importance specific changes for therapeutic effect require further studies.

Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). Methods: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, p < 0.001). This latter group had multiple (all-class) episodes, and two patients had >1000 episodes. There were no clinical, echocardiographic, or laboratory findings able to discriminate patients with SAF from those in sinus rhythm in univariate and multivariable analyses; of note is that the Class C patients showed a higher diastolic blood pressure, resting heart rate, and indexed LA volume. Conclusions. Over a median of 13 days of Holter monitoring, the SAFARI study confirmed the usefulness of small wearable devices in detecting SAF episodes in real-world outpatients at risk for, but with no prior history of, AF.

Hybridised classification and prioritisation of patients with chronic heart diseases (CHDs) can save lives by categorising them on the basis of disease severity and determining priority patients. Such hybridisation is challenging and thus has not been reported in the literature on telemedicine. This paper presents an intelligent classification and prioritisation framework for patients with CHDs who engage in telemedicine. The emergency status of 500 patients with CHDs was evaluated on the basis of multiple heterogeneous clinical parameters, such as electrocardiogram, oxygen saturation, blood pressure and non-sensory measurements (i.e. text frame), by using wearable sensors. In the first stage, the patients were classified according to Dempster–Shafer theory and separated into five categories, namely, at high risk, requires urgent care, sick, in a cold state and normal. In the second stage, hybridised multi-criteria decision-making models, namely, multi-layer analytic hierarchy process (MLAHP) and technique for order performance by similarity to ideal solution (TOPSIS), were used to prioritise patients according to their emergency status. Then, the priority patients were queued in each emergency category according to the results of the first stage. Results demonstrated that Dempster–Shafer theory and the hybridised MLAHP and TOPSIS model are suitable for classifying and prioritising patients with CHDs. Moreover, the groups' scores in each category showed remarkable differences, indicating that the framework results were identical. The proposed framework has an advantage over other benchmark classification frameworks by 33.33% and 50%, and an advantage over earlier benchmark prioritisation by 50%. This framework should be considered in future studies on telemedicine architecture to improve healthcare management. [ABSTRACT FROM AUTHOR]

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation.

INTRODUCTION: Sickle cell anemia is a genetic hereditary disorder, with multifactorial cause for increase susceptibility, to bacterial infection leading to more intensive care unit (ICU) admission, morbidity, and mortality. When it is superadded by morbidities such as Type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and chronic heart disease (CHD), chances of morbidity and mortality will increase multiple times in the ICU. AIM: The aim of this study was to find out the incidence, variation, and load in the microbiological profile of catheter-associated urinary tract infection (CAUTI), depending on the comorbidities associated with these sickle cell anemic tribal patients in the medical ICU (MICU) of a tribal tertiary care center. MATERIALS AND METHODS: This prospective study was conducted in MICU of a tribal tertiary care center from March 2019 to February 2020. It included diagnosed sickle cell anemic tribal patients with microbiologically confirmed cases of CAUTI following urinary catheterization for more than 48 h in the MICU. Demographic and clinical data of these patients were collected. Detailed investigations of the patients with antimicrobial susceptibility and resistance pattern of isolates were collected. RESULTS: In our study, the DAI rate in tribal sickle cell anemic patients was 8.7 per 1000 device days with an incidence of 7.8%. CAUTI was more common in female sex (86.7%), low socioeconomic status (80%), duration of urinary catheter up to first 7 days (66.7%), and age group above 40–60 years (33.3%). The most commonly associated microorganism was Staphylococcus aureus (46.6%) followed by Escherichia coli (13.3%) and Pseudomonas aeruginosa (13.3%). Associated comorbidities were Type 2 DM (20%), cerebrovascular accident (CVA) (20%), ST-segment elevation myocardial infarction (STEMI) (13.3%), CKD (13.3%), and CHD (6.6%). S. aureus 7 (46.6%) and Klebsiella pneumoniae 1 (6.6%) were found in Type 2 DM, Streptococcus pneumoniae 1 (50%) in STEMI, E. coli 2 (13.3%) in CKD and CVA, P. aeruginosa in 1 (6.6%) case each with CVA and septic shock, and Acinetobacter baumannii in 1 (6.6%) case with epilepsy. Resistant antibiotic was ceftriaxone 28.4% to S. aureus and 100% to E. coli. CONCLUSION: Our analysis precisely of this tribal population brings several important and unique findings, which will aid in the development of some new or update guidelines for the prevention of CAUTI to reduce morbidity and mortality in the MICU of a tribal tertiary care center.

Purpose: To evaluate the efficacy, quality of care and safety of Traditional Chinese Medicine (TCM) after Percutaneous Coronary Intervention (PCI). using systematic review and meta-analysis of randomized controlled trials. Methods: Relevant studies published between January 1st 2010 and August 20th, 2021, on traditional Chinese medicine (TCM) and conventional treatment (CT) after PCI were sourced from different databases including CNKI, CBM, Web of Science, PubMed, Embase and Cochrane library. The TCM was composed of preparations of chinese eaglewood, peppermint, radix notoginseng, scabrous elephant foot herb, Tongxinluo, Danhong, Naoxintong capsule, Huxin Formula and liquorice root while the CT included aspirin (100 mg/day), clopidogrel (75 mg/day), and statins. PRISMA guidelines were used. Primary outcome was to evaluate the efficacy, quality of care and safety of TCM versus conventional treatment post percutaneous coronary intervention (PCI). Results: 110 randomized controlled trials (RCTs) were retrieved and analyzed. The results from metaanalysis showed an enhanced left ventricular ejection fraction (LVEF) % among patients that received TCM compared to those on CT [mean difference ± sd (MD)=5.17, 95% CI (3.29-7.06), Z = 5.38, (P < 0.001)]. Further, hypersensitive C-reactive protein (HS-CRP) level in TCM group was found to be relatively lower than that of the CT group (CG) [MD=-1.44, 95% CI (-2.87-0.00), Z=1.96, (P=0.05)]. In terms of safety, TCM group relative risk score in fixed-effect model was lower than that of the CG [RR=0.66, 95% CI (0.40, 1.10), Z=1.66,]. Conclusion: It can be inferred from the results that TCM has more advantages in terms of clinical efficacy, quality of care and safety compared to conventional therapy. However, the lack of substantial research in deploying TCM for the treatment of CHD demands further exploration and strong evidence prior to clinical application of TCM. [ABSTRACT FROM AUTHOR]

Abstract Background Seasonal influenza epidemics yearly affects 5–15% of the world’s population, resulting in 3–5 million serious cases and up to 650,000 deaths. According to the 2017–2019 Italian National Immunisation Plan, free immunisation is offered to the categories at increased risk of experience the complications of the infection (over 65 years old subjects, pregnant women and individuals with underlying conditions, including chronic heart diseases). Rising evidence suggests that influenza can trigger adverse cardiovascular events therefore the vaccination is recommended for secondary prevention of cardiovascular diseases. Despite this, the influenza coverage rate in subjects with chronic heart disease is underestimated. Methods The study investigated the coverage rate in four consecutive influenza seasons (from 2011/2012 to 2014/2015) in subjects that benefit from exemption from paying healthcare costs for chronic heart disease living in Local Health Unit (LHU) of Ferrara (Italy), comparing the databases of exemptions and immunisations. Results The levels of influenza vaccine uptake were unstable, reaching the 50.3% in 2011/2012 immunisation season and falling to 42.2% in the following year. Coverage rates increased with increasing age, without achieving the 75% target, neither in over 65 years old subjects. The logistic regression analysis showed that influenza coverage rates were statistically significant different (p

ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

Today, torasemide is the most prescribed loop diuretic in clinical practice. Its high doses are used mainly in two clinical situations accompanied by hyperhydration: chronic heart failure (CHD) and chronic kidney disease (CKD). The latest guidelines on CHD management, 2019, have defined a clear algorithm for the use of large doses of torasemide, given that the large doses have a lasting diuretic effect. The daily dose is in the range of 50–300 mg of torasemide per day, prescribed continuously and for a long time. The clinical practice evidence demonstrates a high level of natriuretic peptide B to be usually accompanied by a large diuresis. With CKD, large doses of torasemide are in the range of 40–100 mg (200 mg) per day. Given the limitations of the renal water function, which increases proportionally with the degree of CKD, the mode and efficacy of torasemide is different from CHD. With CKD, torasemide is prescribed in doses up to 100 mg 6 days a week, the seventh is a break. When using doses of 100–200 mg, torasemide is prescribed for two days of intake — two days of break. Large doses of torasemide demonstrate high efficacy in reducing/eliminating hyperhydration in CHD and CKD. Their long-term administration reduces overall and cardiovascular mortality rates. The effect of torasemide is enhanced by the simultaneous administration of xipamide. The combination of torasemide and furosemide was determined to be impractical.

Background: Hypertensive heart disease (HHD) is the constellation of abnormalities characterized by cardiac complications. Despite advancements in management of hypertension and access to medical care, incidence of HHD is an alarmingly increasing through time. However, information on determinants of HHD studies is limited in Ethiopia. We assessed determinants of HHD among adult hypertensive patients in Gondar University Referral Hospital, North Ethiopia. Materials and Methods: A case control study was conducted from April 1-26, 2018. Cases were adult hypertensive outpatients with cardiac complications, diagnosed within the last two years and were on follow up and care in Gondar university referral hospital during study period. Controls were adult hypertensive outpatients without history of any of the cardiac complications, diagnosed within the last two years and were on follow up and care in Gondar university referral hospital during study period. A total of 159 participants 53 cases and 106 controls were selected using simple random sampling. Data were collected using checklist and interviewer administered structured questionnaire. Multivariate logistic regression analysis was used to identify predictors of hypertensive heart disease and p-value of 0.05 was used to decide for statistical significance.Result: Most of the cases 70.9% and the controls 54.5% were in the age group of ≥60 years. Hypertensive patients who had family history of cardiovascular disease ((AOR) (Adjusted odds ratio) =4.7, 95% CI: 1.8-11.9), sedentary life style (AOR = 3.2, 95% CI: 1.3-7.8), uncontrolled blood pressure (AOR=4 95% CI: 1.8-9.0), and duration of hypertension ≥10 years (AOR=3, 95% CI: 1.1-8.7) were more likely to develop hypertensive heart disease than their counterparts. Conclusion: Multiple factors predicted HHD. Providing professional advice regarding to physical exercise especially for older individuals and taking early management is highly recommended.

Atrial fibrillation is the most common type of heart arrhythmia that can lead to serious complications, such as ischemic stroke and acute heart failure. Timely diagnosis is problematic in cases of paroxysmal and asymptomatic atrial fibrillation. Therefore, studying of clinical conditions associated with atrial fibrillation represents a relevant scientific problem. There are some well-studied associations including those with arterial hypertension and chronic heart failure. Meanwhile, interconnections with chronic obstructive pulmonary disease, sleep apnea, and other conditions are not so clear and require further investigation. Deep understanding of the above mechanisms will facilitate prompt diagnosis of atrial fibrillation and prevention of its complications. In this review, the epidemiology of atrial fibrillation and major mechanisms underlying relationships between non-valvular atrial fibrillation and associated conditions are highlighted.

Background and purpose: Self-efficacy as one of the main concepts of social cognitive theory could play a major role in different dimensions of health behaviors and empowerment of patients with chronic diseases. The aim of this study was to investigate self-efficacy and predict its related factors in patients with chronic diseases. Materials and methods: This descriptive cross-sectional study was performed in 400 patients with chronic heart and kidney diseases, diabetes, and high blood pressure in three hospitals affiliated to Mazandaran University of Medical Sciences. This study was carried out using a simple random sampling and applying the Chronic Disease Self-efficacy Scale (CDSES). SPSS V23 was used to descriptive and analytical data applying multiple linear regression. Results: The mean score for self-efficacy was 5.17 ± 5.11. Multiple linear regression analysis showed some variables, including the age (CI95:-1.400, -0.573, β= -0.228, P

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation. [ABSTRACT FROM AUTHOR]

Yayoi Nishida,1 Yasuo Takahashi,1 Kotoe Tezuka,1 Keiko Yamazaki,1 Yoichi Yada,2 Tomohiro Nakayama,3,4 Satoshi Asai2 1Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, 2Division of Pharmacology, Department of Biomedical Sciences, 3Division of Companion Diagnostics, 4Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan Background: Multiple comorbidity is common and increases the complexity of the presentation of patients with COPD. This study was a comprehensive analysis of the relationship between a medical history of 22 disease categories and the presence of airflow limitation (AL) without any history of asthma or bronchiectasis, compatible with COPD. Methods: A total of 11,898 Japanese patients aged ≥40 years, who underwent spirometry tests, comprising patients with AL (n=2,309) or without AL (n=9,589), were evaluated. Generalized estimating equations were used to assess the relationship between the presence of AL and each disease. The model was adjusted for age, sex, body mass index (BMI) and pack-years of smoking. Results: In multivariate analysis, female sex (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.52–0.67), age (OR for 10-year age increase: 1.99; CI: 1.90–2.09), BMI (OR for 1 kg/m2 increase: 0.96; CI: 0.95–0.98) and smoking history (

Copyright of Pocki is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Hypertensive heart disease (HHD) is the constellation of abnormalities characterized by cardiac complications. Despite advancements in the management of hypertension and access to medical care, the incidence of HHD is an alarmingly increasing through time. However, there is a dearth of information on the determinants of HHD in Ethiopia. Therefore, this study aimed to assess the determinants of HHD among adult hypertensive patients at Gondar University Referral Hospital, Gondar, Ethiopia. Materials and Methods: This case-control study was conducted from April 1st to 26th in 2018. The cases were adult hypertensive outpatients with cardiac complications who were diagnosed within the last two years and were on follow-up and care in Gondar University Referral Hospital Gondar, Ethiopia, during the study period. On the other hand, the controls were adult hypertensive outpatients without a history of any of the cardiac complications who were diagnosed within the last two years and were on follow-up and care in Gondar University Referral Hospital, Gondar, Ethiopia, during the study period. A total of 159 participants included 53 cases and 106 controls were selected using a simple random sampling method. Data were collected using a checklist, and an interviewer administered a structured questionnaire. Moreover, multivariate logistic regression analysis was used to identify the predictors of hypertensive heart disease. In addition, a p-value of less than 0.05 was considered statistically significant. Results: According to the results of this study, the majority of the cases (70.9%) and controls (54.5%) were in the age group of =60 years. Furthermore, hypertensive patients who had a family history of cardiovascular disease (Adjusted odds ratio (AOR)=4.7, 95% CI: 1.8-11.9), sedentary lifestyle (AOR=3.2, 95% CI: 1.3-7.8), uncontrolled blood pressure (AOR=4, 95% CI: 1.8-9.0), and hypertension duration =10 years (AOR=3, 95% CI: 1.1-8.7) were more likely to develop hypertensive heart disease than their counterparts. Conclusion: Multiple factors predicted HHD; accordingly, it is highly recommended to consider the early management guidelines and provide professional advice regarding physical exercise, especially for older individuals. [ABSTRACT FROM AUTHOR]

Coronary heart disease is the biggest killer in the UK, causing more than a quarter of deaths in 2018 (British Heart Foundation, 2018). Congenital defects are the most common cause of heart disease in pregnancy (Wylie and Bryce, 2016). This article will discuss Marfan syndrome and the impact this has on pregnancy and childbirth. Current literature and research will be appraised and discussed to explore mode of delivery during the second stage of labour and calculate the most appropriate method of delivery. Additionally, this article will address how the midwife can support women with Marfan syndrome during the pregnancy booking, antenatal period and intrapartum period without labelling them, and discuss how this may be achieved in relation to the uncertainty reduction communication theory. [ABSTRACT FROM AUTHOR]

Chronic Chagas heart disease (CCHD affects about 30% of patients with chronic Chagas disease (CCD). Systemic arterial hypertension (SAH) afflicts about 25% of patients with CCD. The association of CCHD with SAH (CCHD-SAH) predisposes patients to develop chronic heart failure. The role of cytokines in disease progression in patients with CCHD-SAH is unknown. Accordingly, the aim of this study was to evaluate the plasma levels of cytokines expressing the Th1, Th2, Th17 pattern, as well as Treg cytokines, TNF-alpha, IL-1β, IL-8, IL-7 in patients with SAH-CCHD to get insight into the immunomodulation process in patients with this condition. Fifteen patients with CCHD, 22 patients with CCHD-SAH, and 28 controls were studied. All patients underwent history-taking, physical examination, 12-lead resting ECG, chest X-ray, and Doppler-echocardiogram. Ten of 15 (66%) patients with CCHD, and 16 of 22 (73%) patients with CCHD-SAH had decreased left ventricular ejection fraction (p > 0.05). Cytokines levels were performed on plasma samples using the ELISA method. Overall, proinflammatory, anti-inflammatory, and regulatory cytokine levels were increased in patients with CCHD-SAH in comparison to patients with CCHD and controls. However, such a difference was higher regarding IL-2, IL-5, IL-17, IL-12, and TNF-alpha cytokine levels, respectively. Cytokine levels were higher in CCHD patients in comparison to controls. Patients with CCHD-SAH have increased plasma levels of pro-inflammatory, anti-inflammatory, and regulatory cytokines in comparison with CCHD patients, thus suggesting a higher level of immunomodulation in patients with CCHD-SAH. [ABSTRACT FROM AUTHOR]

Background and purpose: Self-efficacy as one of the main concepts of social cognitive theory could play a major role in different dimensions of health behaviors and empowerment of patients with chronic diseases. The aim of this study was to investigate self-efficacy and predict its related factors in patients with chronic diseases. Materials and methods: This descriptive cross-sectional study was performed in 400 patients with chronic heart and kidney diseases, diabetes, and high blood pressure in three hospitals affiliated to Mazandaran University of Medical Sciences. This study was carried out using a simple random sampling and applying the Chronic Disease Self-efficacy Scale (CDSES). SPSS V23 was used to descriptive and analytical data applying multiple linear regression. Results: The mean score for self-efficacy was 5.17 ± 5.11. Multiple linear regression analysis showed some variables, including the age (CI95:-1.400, -0.573, β= -0.228, P <0.001), educational level (CI95: 1.311, 6.000, β=0.149, P= 0.002), and income level (CI95:12.585, 23.901, β= 0.319, P<0.001) as the predictors of self-efficacy in chronic patients. Conclusion: In this study, the majority of patients with chronic diseases had a moderate level of self-efficacy. Chronic diseases are highly prevalent today, therefore, more precise planning is needed to promote self-efficacy which is the main factor in improving self-care and health behaviors of patients with chronic diseases. [ABSTRACT FROM AUTHOR]

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Science must address a deep human concern, pain and suffering and how can an individual, without drugs and surgery, self-heal? Historical knowledge of Coulombic, Gaussian and Photonic energy in medicine and the science of human organic life energy or Qi is required to heal ourselves. How can we couple singular individual consciousness of ancient practice techniques within a scientific frame? First, where does Qi fit into science? The properties of organic and inorganic oneness, comparing the physiology of human Enlightenment to the stable state of helium at absolute temperature gives information on how to approach disease. A non-invasive diagnostic technique of the Omura O-ring is capable of testing meridian theory, giving light on Oriental medicine's limitations as compared to modern neuro-science of the dermatome. Treatment through self-help techniques of Chronic Heart Disease and a serious spinal injury gives us data in which to evaluate this approach. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease is the leading cause of adult mortality and morbidity throughout the world. Well known risk factors independently or combined are involved in both atherosclerosis and myocardial infarction. Recent data have shown that viral and bacterial infections may also contribute to acute thromboembolic events; hence a case control study was carried out. Aims and Objective: To investigate the possible association between periodontal health and coronary artery disease, in patients with Acute Myocardial Infarction (AMI) and Coronary Heart Disease (CHD). Material and Methods: 150 patients, 75 with AMI and 75 with CHD were included in the study. Data on hypertension, diabetes, smoking status and alcohol consumption were recorded. AMI patients were clinically examined 3-4 days after admission to the coronary care unit. Clinical examination of CHD patients was carried out during the hospital stay. All teeth excluding third molars were studied and clinical data were recorded regarding Plaque Index, Simplified Oral Hygiene Index, Gingival Index, Gingival Bleeding Index, Probing Depth and Clinical Attachment Loss. Results: Percentage of sites exhibiting bleeding on probing and the number of sites with more probing depth were significantly higher among AMI patients than those with CHD (P=0.05 and p=0.001 respectively).There was abundant plaque and debris around all tooth surfaces in AMI patients (p=0.001). Conclusion: Overall result of this case control study showed an association between periodontitis and acute myocardial infarction.

The paper deals with the analysis of studies of the role of the bone morphogenetic proteins fibroblast growth factor 23 (FGF-23) and Klothno in the development of vascular wall calcification in chronic renal disease (CRD). FGF-23 is shown to be an important phosphaturic hormone that inhibits hypercalcemic and hyperphosphatemic effects of elevated serum vitamin D concentrations. There is evidence that there is an association between high serum FGF-23 levels and vascular wall calcification irrespective of the content of phosphorus and parathyroid hormone. Most authors regard FGF-23 as a potential uremic toxin in patients with end-stage CRD. There are data that support the renoprotective value of the morphogenetic protein Klotho whose expression in CRD is decreased.

The review is devoted to an actual problem of modern cardiology – atrial fibrillation (AF) treatment in patients with chronic heart failure (CHF). Multicenter clinical trials demonstrated that CHF patients have AF more often than individuals without CHF. Algorhythms for choosing optimal antiarrhythmic therapy in AF and CHF are proposed. Possible therapeutic strategies, including use of ACE inhibitors and angiotensin II receptor antagonists, are discussed.

Size changes in muscle fibers of subjects with chronic heart disease (CHD) have been reported, although a consensus has not been achieved. The aims of the present study were to investigate a possible association between CHD and fiber size changes in the brachial biceps compared to subjects without heart disease. Forty-six muscle samples were obtained in autopsies of individuals (13 to 84 years) without neuromuscular disorders, 19 (10 males and 9 females) with, and 27 (14 males and 13 females) without CHD. In all cases muscle sections were stained with hematoxylin and eosin and processed for the visualization of myofibrillar ATPase activity. The lesser diameter of type 1 and type 2 fibers was obtained tracing their outlines (at least 150 fibers of each type per sample) onto an image analyzer connected to a computer. The results were analyzed statistically comparing males and females with and without CHD. Type 1 fiber mean lesser diameters were 51.51 and 54.52 µm in males (normal range 34-71 µm) and 45.65 and 55.42 µm in females (normal range 34-65 µm) without and with CHD, respectively; type 2 fibers measured 54.31, 58.23, 41.15, and 49.57 µm, respectively (normal range 36-79 µm for males and 32-59 µm for females). No significant difference in fiber size was detected in 24 males with and without CHD, while in 22 females there was a significant increase in size in those with cardiomyopathy. We concluded that CHD does not determine significant changes in fiber size. However, in females, there is some hypertrophy which, despite within normal range, may reflect morphologic heterogeneity of the sample, or the daily life activities in the upper limbs as a compensatory mechanism to fatigability that affect predominantly the lower limbs in subjects with CHD.