RESUMO
Aims: Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results: The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC-AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6â min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65-90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696â h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4-4.9); 2nd-4th week: 0.55% (0.33-0.93)]. Conclusion: Remote, digitally supported consumer-electronics-based screening is feasible in older European adults and identifies atrial arrhythmias in 5% of participants within 4 weeks of monitoring (NCT04579159).
RESUMO
BACKGROUND: Despite the widespread and increasing use of NOACs in Saudi Arabia, there is a lack of contemporary guidance specific to the region. In particular, guidance on NOAC use in high-risk patients who are more likely to experience bleeding with oral anticoagulant therapy is needed. There is an unmet need for a review of contemporary evidence coupled with expert insights on safe and effective NOAC use in high-risk patients with AF in Saudi Arabia. RESEARCH DESIGN AND METHODS: This article provides a detailed review of contemporary literature on NOAC use in high-risk patients with AF. Additionally, key gaps in the literature are identified and expert insights are shared to guide effective management of patients and the significance of local data is evaluated with respect to challenges in optimizing the use of NOACs. CONCLUSIONS: This article provides information that complements and expands on existing reviews and guidelines on NOAC use in patients with AF, with a focus on challenges specific to the Saudi Arabian context with the potential to make a positive contribution to the medical community in Saudi Arabia and in other nations.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Hemorragia/induzido quimicamente , Administração Oral , Humanos , Assistência ao Paciente , Arábia Saudita , Acidente Vascular Cerebral/prevenção & controleRESUMO
BACKGROUND: In 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed from separate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door-to-balloon (DTB) time, in hospital and 1 year mortality. METHODS: Retrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorized--pre- (Group 1) and post- (Group 2) introduction of the computerised alert protocol. RESULTS: OOH PPCI was performed for 793 patients (mean age 61, 73.4% male)--295 in Group 1 and 498 in Group 2. Median DTB times were 92 min (interquartile range [IQR] 75-111) for Group 1 and 76 min (IQR 64-97) for Group 2 (p < 0.0001). Forty-eight percent achieved DTB in ≤ 90 min in Group 1 compared to 70% in Group 2 (p < 0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient -0.09, p = 0.03 for linear regression and OR 2.8, 95% CI 1.6-5.0, p < 0.0001 for logistic regression). In hospital mortality was 4.1% in Group 1 and 5% in Group 2 (p = 0.60). All-cause mortality at 1 year was 6.1% in Group 1 and 9.9% in Group 2 (p = 0.09). CONCLUSIONS: Simultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality.
Assuntos
Serviços Médicos de Emergência/métodos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Tempo para o Tratamento/organização & administração , Transporte de Pacientes/normas , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Reino Unido/epidemiologiaAssuntos
Insuficiência Cardíaca/etnologia , Fatores Etários , Idoso , Ásia/etnologia , Região do Caribe/etnologia , Doença das Coronárias/complicações , Doença das Coronárias/etnologia , Complicações do Diabetes , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Hipertensão/etnologia , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Projetos de Pesquisa , Fatores de Risco , Reino Unido/epidemiologiaAssuntos
Síncope/etiologia , Torsades de Pointes/diagnóstico , Bisoprolol/uso terapêutico , Remoção de Dispositivo , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Humanos , Masculino , Pessoa de Meia-Idade , Simpatolíticos/uso terapêutico , Torsades de Pointes/tratamento farmacológicoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Cardíacas/tratamento farmacológico , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Etoposídeo/administração & dosagem , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Ifosfamida/administração & dosagem , Leucemia-Linfoma de Células T do Adulto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Indução de Remissão , Ultrassonografia , Vincristina/administração & dosagemAssuntos
Dor no Peito/diagnóstico , Dor no Peito/etiologia , Continuidade da Assistência ao Paciente/organização & administração , Tratamento de Emergência/métodos , Dor no Peito/terapia , Diagnóstico Diferencial , Unidades Hospitalares/organização & administração , Hospitais Comunitários/organização & administração , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
The aquaporins are a rapidly expanding family of highly conserved proteins which function as transmembrane water channels. We have previously shown that the gene for aquaporin-1 (AQP-1) is expressed in rat, aortic vascular smooth muscle cells (VSMCs) implying a specific role for AQP-1 in vascular function. In this study we set out to document the expression of AQP-1 in human arteries and found mRNA and protein in normal endothelial and VSMCs of human arteries and capillaries and in a subset of VSMCs in human atherosclerotic plaques. Secondly, we examined the regulation of AQP-1 gene expression during vascular development and following vascular injury. Studies in the rat demonstrated that AQP-1 mRNA is induced in the neonatal aorta at week 2 of postnatal development and that the protein is present in neointimal VSMCs following balloon injury. Finally, by measuring the rate of change in cell size induced by changes in external osmolarity and demonstrating that water transport can be inhibited with mercuric chloride, we show that AQP-1 is responsible for water transport across human VSMC membranes. Thus, this study provides evidence for a hitherto unrecognised role for aquaporins in mediating rapid water transport across human VSMC membranes. By analogy with other tissues, these data argue for an important role for AQP-1 in regulating transcellular fluid flow and tissue hydration.
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Aquaporinas/biossíntese , Músculo Liso Vascular/metabolismo , Animais , Aorta , Aquaporina 1 , Aquaporinas/genética , Transporte Biológico , Antígenos de Grupos Sanguíneos , Água Corporal/metabolismo , Permeabilidade Capilar , Artérias Carótidas , Membrana Celular/metabolismo , Células Cultivadas , Expressão Gênica , Humanos , Músculo Liso Vascular/citologia , Ratos , Ratos WistarRESUMO
The recent discovery of aquaporins, a family of highly conserved water channel proteins, which are expressed in both eukaryotes and prokaryotes, has provoked a re-evaluation of the physiology of water transport in all organisms. So far, seven distinct aquaporins have been characterised in mammals, but highly homologous family members have also been found in amphibians, insects, plants and bacteria. These transmembrane proteins serve to facilitate water transport down osmotic gradients with low activation energy. Alterations in channel expression, cellular targeting and perhaps channel permeability regulate membrane water transport. Naturally occurring and experimentally produced mutations in aquaporins cause a variety of perturbations of water homeostasis. Manipulation of aquaporin expression may have a therapeutic role in several disease processes including cardiac failure and the ascites associated with liver disease.
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Aquaporinas , Membrana Celular/metabolismo , Canais Iônicos/metabolismo , Proteínas de Membrana , Água/metabolismo , Animais , Aquaporina 1 , Aquaporina 2 , Aquaporina 3 , Aquaporina 4 , Aquaporina 5 , Aquaporina 6 , Bactérias , Transporte Biológico , Homeostase , Canais Iônicos/química , PlantasAssuntos
Aquaporinas , Água Corporal/metabolismo , Canais Iônicos , Animais , Aquaporina 1 , Aquaporina 2 , Aquaporina 3 , Aquaporina 4 , Aquaporina 6 , Antígenos de Grupos Sanguíneos , Proteínas do Olho/fisiologia , Humanos , Canais Iônicos/genética , Canais Iônicos/metabolismo , Canais Iônicos/fisiologia , Túbulos Renais Coletores/metabolismo , Túbulos Renais Coletores/fisiologia , Glicoproteínas de Membrana/fisiologiaRESUMO
The in vivo diagnosis of right atrial thrombus is difficult by transthoracic echocardiography and it is likely that small thrombi are underdiagnosed using this approach. Transoesophageal echocardiography provides an unobstructed view of cardiac structures and the great vessels. In this report we describe the findings in five patients with right atrial thrombi that illustrate the potential usefulness of transoesophageal echocardiography for both the initial diagnosis and the subsequent management of these patients.
Assuntos
Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adulto , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias das Glândulas Suprarrenais/complicações , Insuficiência Cardíaca/etiologia , Feocromocitoma/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/metabolismo , Adulto , Catecolaminas/metabolismo , Humanos , Masculino , Feocromocitoma/diagnóstico , Feocromocitoma/metabolismoRESUMO
Bacterial endocarditis may present with acute chest pain due to coronary embolization and mimics acute myocardial infarction secondary to coronary atherosclerosis. We present the first case report of coronary embolization secondary to aortic valve endocarditis treated with standard doses of streptokinase and aspirin. The patient survived but sustained a large myocardial infarction and a major gastrointestinal bleed. Infective endocarditis should be considered in all patients presenting with acute chest pain. When myocardial infarction is due to coronary embolism from endocarditic valves standard thrombolysis regimes should be avoided.