The prevalence of atrial fibrillation in Greenland: a register-based cross-sectional study based on disease classifications and prescriptions of oral anticoagulants.

Previous studies of the prevalence of atrial fibrillation (AF) in Greenland are based on either single-point electrocardiograms (ECGs) or patients admitted with stroke. This study estimates the prevalence of AF based on disease classifications in the electronic medical record system (EMR) and prescriptions of oral anticoagulants (OACs). Patients given a diagnose classification code for AF or atrial flutter or prescribed the vitamin K antagonist Warfarin or the direct-acting oral anticoagulant Rivaroxaban were identified in the EMR. Descriptive data and selected laboratory values were extracted, and a minimum CHA2DS2-VASc score was calculated for the 790 patients identified in the EMR (66% men). A total prevalence of AF of 1.4% was found in the general population (1.8% among men and 1.0% among women), with a significantly lower prevalence among women younger than 70 years. There was a significant increase in AF-prevalence with advancing age (p<0.001) for both men and women. A minimum CHA2DS2-VASc was estimated and app. 10% of the patients may be undertreated with OACs. The prevalence of AF found in this study is higher than that found in previous studies in Greenland and comparable to the prevalence found in other Western countries, indicating that AF is common in Greenland.

Elevated levels of interleukin-12/23p40 may serve as a potential indicator of dysfunctional heart rate variability in type 2 diabetes.

BACKGROUND: Systemic inflammatory processes plausibly contribute to the development of cardiovascular complications, causing increased morbidity and mortality in type 2 diabetes. Circulating inflammatory markers, i.e., interleukin (IL)-6 and tumour necrosis factor-α, are associated with neurocardiac measures. We examined a broad panel of various inflammatory and inflammation-related serum markers to obtain more detailed insight into the possible neuro-immune interaction between cardiovascular regulation and systemic level of inflammation. METHODS: Serum samples from 100 participants with type 2 diabetes were analysed. Heart rate variability, cardiovascular autonomic reflex tests, and cardiac vagal tone tests were performed based on electrocardiographic readings. Data regarding covariates (demographic-, diabetes-, and cardiovascular risk factors) were registered. RESULTS: Increased serum levels of IL-12/IL-23p40 (p < 0.01) and intercellular adhesion molecule (ICAM)-1 (p < 0.007) were associated with diminished heart rate variability measures. After all adjustments, the associations between IL-12/23p40, SDANN and VLF persisted (p = 0.001). Additionally, serum levels of vascular endothelial growth factor (VEGF)-C were associated with response to standing (p = 0.005). DISCUSSION: The few but robust associations between neurocardiac regulation and serum markers found in this study suggest systemic changes in proinflammatory, endothelial, and lymphatic function, which collectively impacts the systemic cardiovascular function. Our results warrant further exploration of IL-12/IL-23p40, ICAM-1, and VEGF-C as possible cardiovascular biomarkers in T2D that may support future decisions regarding treatment strategies for improved patient care.

Over 60 years of age as an independent prognostic factor of in-hospital mortality among COVID-19 patients: a cohort study in an Iranian high-incidence area.

OBJECTIVES: COVID-19 continues to cause devastation throughout the world. Various factors influence the perioperative course and prognosis of COVID-19. This study aims to collate the independent prognostic factors among hospitalised COVID-19 patients in east Iran. STUDY DESIGN: In this cohort study, all patients with a confirmed diagnosis of COVID-19 between 19 February 2020 and 1 August 2020 who were admitted to nine public hospitals of South Khorasan province, Iran, were enrolled. METHODS: Univariate analysis (chi-square [χ2], and Mann-Whitney U test) and multiple logistic regression were performed. RESULTS: This study included 1290 participants; 676 patients (52.4%) were male. A total of 1189 (92.2%) recovered, and 101 (7.8%) died. The results show that in-hospital mortality increases with advanced age (the optimal cut-off point = 62 years). The following three variables were shown to have the most significant role in in-hospital mortality: age >60 years (odds ratio [OR] = 8.01, 95% confidence interval [CI] 4.8-13.35), shortness of breath (OR = 2.65, 95% CI: 1.4-69.17) and atypical radiological manifestations in a chest X-ray on admission (OR = 2.16, 95% CI: 1.3-28.64). In the univariate analysis, associated comorbidities, such as cardiovascular diseases, influenced the in-hospital mortality rate, while the same could not be replicated in the multiple variable analysis. CONCLUSIONS: This study revealed the potential predictors of COVID-19 and highlighted the need to be cautious with advanced age and heightened clinical symptoms at the time of admission.

The efficacy of probiotics in experimental autoimmune encephalomyelitis (an animal model for MS): a systematic review and meta-analysis.

Probiotics immunomodulatory properties and their beneficial effects for diseases such as multiple sclerosis (MS) are reported by several studies. The current systematic review and meta-analysis aimed to investigate the favourable effects of probiotics in improving experimental autoimmune/allergic encephalomyelitis (EAE) as an animal model of MS. We systematically searched Scopus, Web of Sciences (ISI), and PubMed databases to identify relevant studies from the inception of these databases to December 2019. A total of 15 animal studies met the inclusion criteria, while no human study met the inclusion criteria. The association between consumption of probiotics and each sign was calculated using the producing pooled odd ratios (95% confidence interval [95% CI]) in a random effect model. The meta-analysis revealed the significant effect of probiotics on the incidence of EAE, weight gain, and clinical symptoms. However, the effects of probiotics on the duration of the disease varied by probiotic strain. The administration of probiotics was associated with a significant reduction in the risk of mortality only in female animals. Moreover, the meta-analysis revealed the promising effects of probiotics on the prevention and management of EAE.

Global prevalence of latent toxoplasmosis in pregnant women: a systematic review and meta-analysis.

BACKGROUND: Toxoplasma gondii infection, if acquired as an acute infection during pregnancy, can have substantial adverse effects on mothers, fetuses and newborns. Latent toxoplasmosis also causes a variety of pathologies and has been linked to adverse effects on pregnancy. OBJECTIVE: Here, we present results of a comprehensive systematic review and meta-analysis of the global prevalence of latent toxoplasmosis in pregnant women. DATA SOURCE: We searched PubMed, EMBASE, Web of Science, SciELO and Scopus databases for relevant studies that were published between 1 January 1988 and 20 July 2019. STUDY ELIGIBILITY CRITERIA: All population-based, cross-sectional and longitudinal studies reporting the prevalence of latent toxoplasmosis in healthy pregnant women were considered for inclusion. PARTICIPANTS: Pregnant women who were tested for prevalence of latent toxoplasmosis. INTERVENTIONS: There were no interventions. METHOD: We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CIs). We grouped prevalence data according to the geographic regions defined by the World Health Organization (WHO). Multiple subgroup and meta-regression analyses were performed. RESULTS: In total, 311 studies with 320 relevant data sets representing 1 148 677 pregnant women from 91 countries were eligible for inclusion in the meta-analysis. The global prevalence of latent toxoplasmosis in pregnant women was estimated at 33.8% (95% CI, 31.8-35.9%; 345 870/1 148 677). South America had the highest pooled prevalence (56.2%; 50.5-62.8%) of latent toxoplasmosis in pregnant women, whereas the Western Pacific region had the lowest prevalence (11.8%; 8.1-16.0%). A significantly higher prevalence of latent toxoplasmosis was associated with countries with low income and low human development indices (p < 0.001). CONCLUSION: Our results indicate a high level of latent toxoplasmosis in pregnant women, especially in some low- and middle-income countries of Africa and South America, although the local prevalence varied markedly. These results suggest a need for improved prevention and control efforts to reduce the health risks to women and newborns.

[Impact of occupational noise in the development of arterial hypertension: A survey carried out in a company of electricity production]. / Impact du bruit professionnel sur le développement de l'hypertension artérielle : enquête réalisée au sein d'une centrale de production d'électricité et de gaz en Tunisie.

BACKGROUND: Noise pollution is one of the major environmental pollutants that can adversely affect public health. Cardiovascular diseases are the primary out-auditory adverse outcome caused by occupational noise exposure. AIMS: To investigate the association between occupational exposure to high level of noise and blood pressure among a group of workers in a company of electricity production in the Centre of Tunisia. MATERIAL AND METHODS: A total of 120 occupational noise-exposed workers and 120 non-exposed employees were recruited to conduct a cross-sectional survey exploring the association between occupational noise-exposed and arterial hypertension. Data collection was based on a questionnaire, a clinical exam and biomarkers. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. The occupational noise level was measured with a portable calibrated sound meter. Multiple logistic regression was used to calculate the odds ratio (OR) and 95 % confidence interval (CI) of noise exposure adjusted by potential confounders. RESULTS: The noise level to which our population was exposed ranged from 75dB to 103dB with an average noise level of 89dB. Mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and the prevalence of hypertension were significantly higher in exposed individuals than in non-exposed. In multivariate analysis, elevated SBP in exposed workers was associated with high-salt diet (OR adjusted=1.71, 95% CI adjusted [1.14-1.98]) and occupational seniority more than 8 years (adjusted OR=5.31, 95% CI [2.22-12.72]). The factors associated with high BP in the exposed group were diabetes (OR adjusted to 15.31; 95% adjusted CI [2.61-89.58]), history of hypertension in the family (OR adjusted to 11.46; 95% adjusted CI [5.18-83][1.58-83.05]), mean of age (OR adjusted to 6.65; 95% adjusted CI [1.87-23.59]) and high-salt diet (OR adjusted to 0.29; 95% adjusted CI [0.09-0.95]). CONCLUSION: Occupational chronic noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure in companies of electricity production.

Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study.

Aims: There is a paucity of studies investigating a dose-dependent association between beta-blocker therapy and risk of outcome. In a nationwide cohort of primary prevention implantable cardioverter-defibrillator (ICD) patients, we aimed to investigate the dose-dependent association between beta-blocker therapy and risk of ventricular tachyarrhythmias (VT/VF), heart failure (HF) hospitalizations, and death. Methods and results: Information on ICD implantation, endpoints, comorbidities, beta-blocker usage, type, and dose were obtained through Danish nationwide registers. The two major beta-blockers carvedilol and metoprolol were examined in three dose levels; low (metoprolol ≤ 25 mg; carvedilol ≤ 12.5 mg), intermediate (metoprolol 26-199 mg; carvedilol 12.6-49.9 mg), and high (metoprolol ≥ 200 mg; carvedilol ≥ 50 mg). Time to events was investigated utilizing multivariate Cox models with beta-blocker as a time-dependent variable. From 2007 to 2012, 2935 first-time ICD devices were implanted. During follow-up, 399 patients experienced VT/VF, 728 HF hospitalizations and 361 died. As compared with patients not on beta-blockers, low, intermediate, and high dose had significantly reduced risk of HF hospitalizations {hazard ratio (HR) = 0.68 [0.54-0.87], P = 0.002; HR = 0.53 [0.42-0.66], P < 0.001; HR = 0.43 [0.34-0.54], P < 0.001} and death (HR = 0.47 [0.35-0.64], P < 0.001; HR = 0.29 [0.22-0.39], P = 0.001; HR = 0.24 [0.18-0.33], P < 0.001). For the endpoint of VT/VF, only intermediate and high dose beta-blocker was associated with significantly reduced risk (HR = 0.58 [0.43-0.79], P < 0.001; HR = 0.53 [0.39-0.72], P < 0.001). No significant difference was found between comparable doses of carvedilol and metoprolol on any endpoint (P = 0.06-0.94). Conclusion: In primary prevention ICD patients, beta-blocker therapy was associated with significantly reduced risk of all endpoints, as compared with patients not on beta-blocker, with the suggestion of a dose-dependent effect. No detectable difference was found between comparable doses of carvedilol and metoprolol.

Cardiac vagal tone, a non-invasive measure of parasympathetic tone, is a clinically relevant tool in Type 1 diabetes mellitus.

AIMS: To compare a novel index of parasympathetic tone, cardiac vagal tone, with established autonomic variables and to test the hypotheses that (1) cardiac vagal tone would be associated with established time and frequency domain measures of heart rate and (2) cardiac vagal tone would be lower in people with Type 1 diabetes than in a matched healthy cohort and lower still in people with established neuropathy. METHODS: Cardiac vagal tone is a validated cardiometrically derived index of parasympathetic tone. It is measured using a standard three-lead electrocardiogram which connects, via Bluetooth, to a smartphone application. A 5-min resting recording of cardiac vagal tone was undertaken and observational comparisons were made between 42 people with Type 1 diabetes and peripheral neuropathy and 23 without peripheral neuropathy and 65 healthy people. In those with neuropathy, 24-h heart rate variability values were compared with cardiac vagal tone. Correlations between cardiac vagal tone and clinical variables were also made. RESULTS: Cardiac vagal tone was lower in people with established neuropathy and Type 1 diabetes in comparison with healthy participants [median (interquartile range) linear vagal scale 3.4 (1.6-5.5 vs 7.0 (5.5-9.6); P < 0.0001]. Cardiac vagal tone was positively associated with time (r = 0.8, P < 0.0001) and frequency domain markers of heart rate variability (r = 0.75, P < 0.0001), representing established measures of parasympathetic function. Cardiac vagal tone was negatively associated with age (r=-0.32, P = 0.003), disease duration (r=-0.43, P < 0.0001) and cardiovascular risk score (r=-0.32, P = 0.006). CONCLUSIONS: Cardiac vagal tone represents a convenient, clinically relevant method of assessing parasympathetic nervous system tone, potentially facilitating the earlier identification of people with Type 1 diabetes who should undergo formal autonomic function testing.

An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint.

UNLABELLED: WHAT IS KNOWN ON THE SUBJECT?: There is emerging evidence highlighting the counter therapeutic impact of the use of restraint and promoting the minimization of this practice in mental health care. Mental health nurses are often the professional group using restraint and understanding factors influencing their decision-making becomes critical. To date, there are no other published papers that have undertaken a similar broad search to review this topic. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Eight emerging themes are identified as factors influencing mental health nurses decisions-making in the use of restraint. The themes are: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'. 'Last resort' appears to be the mantra of acceptable restraint use, although, to date, there are no studies that specifically consider what this concept actually is. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These findings should be considered in the evaluation of the use of restraint in mental health settings and appropriate strategies placed to support shifting towards restraint minimization. As the concept of 'last resort' is mentioned in many policies and guidelines internationally with no published understanding of what this means, research should prioritize this as a critical next step in restraint minimization efforts. INTRODUCTION: While mechanical and manual restraint as an institutional method of control within mental health settings may be perceived to seem necessary at times, there is emergent literature highlighting the potential counter-therapeutic impact of this practice for patients as well as staff. Nurses are the professional group who are most likely to use mechanical and manual restraint methods within mental health settings. In-depth insights to understand what factors influence nurses' decision-making related to restraint use are therefore warranted. AIM: To explore what influences mental health nurses' decision-making in the use of restraint. METHOD: An integrative review using Cooper's framework was undertaken. RESULTS: Eight emerging themes were identified: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'. These themes highlight how mental health nurses' decision-making is influenced by ethical and safety responsibilities, as well as, interpersonal and staff-related factors. CONCLUSION: Research to further understand the experience and actualization of 'last resort' in the use of restraint and to provide strategies to prevent restraint use in mental health settings are needed.

No effect of high-dose atorvastatin on leukotriene B4 formation from neutrophils in patients treated with coronary bypass surgery: a randomized placebo-controlled double-blinded trial with a crossover design.

Inflammation plays a pivotal role in the pathophysiology of cardiovascular disease, (CVD) and leukotrienes may play a role in atherogenesis. Statins reduce mortality from CVD by reducing LDL cholesterol and potentially by other (pleiotropic) mechanisms. The aim of this study was to investigate if atorvastatin exerts an anti-inflammatory effect by reducing leukotriene B4 (LTB4) formation from stimulated neutrophils in patients treated with coronary artery bypass grafting. The study was a randomized, placebo-controlled, double-blinded crossover study. Patients (n=80) were allocated to 80 mg atorvastatin or placebo for 6 weeks before crossing over to the opposite treatment for another 6 weeks. There was no significant correlation between baseline LDL cholesterol levels on formation of LTB4, and atorvastatin had no effect on LTB4 formation. Hence, this study does not support any effect of atorvastatin on LTB4 formation as part of the explanation for its beneficial effect on CVD.

Lanthanide Recognition: an Asymetric Erbium Microsensor Based on a Hydrazone Derivative.

N'-(2-hydroxy-1,2-diphenylethylidene)benzohydrazide (HDB) was found tohave a very selective and sensitive behavior towards erbium(III) ions, in comparison tothirteen lanthanide ions, inner transition and representative metal ions and was hence usedas a neutral ion carrier in construction of an Er(III) microelectrode. Theoretical calculationsand conductance studies of HDB to erbium and some other metal ions were carried out andconfirmed selectivity toward Er(III) ions.The best performance was obtained with a membrane contain 3% potassium tetrakis(p-chlorophenyl)borate (KTpClPB) as an anionic additive, 72% dibutyl phthalate (DBP) assolvent mediator, 5% HDB, and 20% poly(vinyl chloride) (PVC). The proposed Er(III)microelectrode exhibits a near Nernstian response of 17.5±0.5 mV per decade of erbiumactivity, and a very wide linear range 1.0×10-3-3.0×10-10 M. It can work well in the pHrange of 3.0-9.0. The lower detection limit (LDL) of the microelectrode was calculated tobe 2.0×10-10 M.

Prediction of selectivity coefficients of a theophylline-selective electrode using MLR and ANN.

The selectivity coefficient of 24 interfering compounds (drugs, amino acids and organic compounds) of a theophylline-selective electrode was predicted using an artificial neural network (ANN). The multiple linear regression (MLR) technique was used to select the descriptors as inputs for the artificial neural network. The neural network employed here is a connected back-propagation model with a 2-2-1 architecture. Two topological indices for the interfering compounds, namely, Narumi harmonic topological index, HNar, and sum of topological distances between nitrogen and oxygen, T(Ncdots, three dots, centeredO), were taken as inputs for the ANN. Standard errors of training and prediction were 0.954 and 0.945, respectively, for the MLR model and 0.032 and 0.007, respectively, for the ANN model. Two topological indices for the interference of the electrode were taken as inputs for ANN.

QSAR analysis for ADA upon interaction with a series of adenine derivatives as inhibitors.

The kinetic parameters of adenosine deaminase such as Km and Ki were determined in the absence and presence of adenine derivatives (R1-R24) in sodium phosphate buffer (50 mM; pH 7.5) solution at 27 degrees C. These kinetic parameters were used for QSAR analysis. As such, we found some theoretical descriptors to which the binding affinity of adenosine deaminase (ADA) towards several adenine nucleosides as inhibitors is correlated. QSAR analysis has revealed that binding affinity of the adenine nucleosides upon interaction with ADA depends on the molecular volume, dipole moment of the molecule, electric charge around the N1 atom, and the highest of positive charge for the related molecules.

Use of lipid-lowering drugs during 1991-98 in Northern Jutland, Denmark.

AIMS: To examine a) the use of lipid-lowering drugs in North Jutland County in Denmark from 1991 to 1998 and b) the pattern of usage according to sex and age. METHODS AND RESULTS: We used the Pharmaco-Epidemiological Prescription Database in the county to identify all reimbursed prescriptions for lipid-lowering therapy from 1991 to 1998. One-year incidence rates (IR) and prevalence (P) of the use of lipid-lowering drugs were calculated. Both IR and P of patients in lipid-lowering therapy were stable until 1994, with the IR below 100 per 100 000 for both sexes. The IR then increased from 59.9 to 236.5 per 100 000 person-years in 1998 for women, and from 88.6 to 322.8 per 100 000 person-years for men. The utilization patterns were identical between the sexes. Thus, in both women and men the highest prevalence and incidence rates of lipid-lowering drug therapy were seen in the 60-69-year-olds. Furthermore, the marked increase in both prevalence and incidence of persons on lipid-lowering drug therapy between 1994 and 1998 was the result of an increased number of prescriptions in the 50-59, 60-69 and 70 + years olds, in both women and men. There was a remarkable 4-5 fold increase in the numbers of new patients who received statins during the same period. CONCLUSIONS: The overall use of lipid-lowering drugs has increased markedly over the last few years in Northern Jutland, Denmark. The increase began following publication of the first major trial documenting the benefit of therapy with statins.

Marine n-3 fatty acids: basic features and background.

There is some evidence from epidemiology that intake of n-3 polyunsaturated fatty acids (PUFA) from seafood may protect against coronary artery disease (CAD). This hypothesis is further supported from animal data showing a beneficial effect of n-3 PUFA on thrombosis and atherosclerosis in animals fed fish oils in most, but not all, studies. There are several mechanisms by which an increased intake of marine n-3 PUFA may protect against CAD; the most universal finding is a reduction of plasma triglycerides. It is puzzling, however, that a very low amount of n-3 PUFA, with no known beneficial biochemical effects, seems to be cardioprotective. It has therefore been of paramount interest to perform clinical trials. Such evidence and trials are discussed in later chapters, and the results have been very encouraging.