Evaluating Biomarkers as Tools for Early Detection and Prognosis of Heart Failure: A Comprehensive Review.

There is a high prevalence of heart failure (HF) worldwide, which has significant consequences for healthcare costs, patient death and quality of life. Therefore, there has been much focus on finding and using biomarkers for early diagnosis, prognostication and therapy of HF. This overview of the research presents a thorough examination of the current state of HF biomarkers and their many uses. Their function in diagnosing HF, gauging its severity and monitoring its response to therapy are all discussed. Particularly promising in HF diagnosis and risk stratification are the cardiac-specific biomarkers, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Markers of oxidative stress, extracellular matrix, renal function, inflammation and cardiac peptides have shown promise in evaluating HF severity and prognosis. MicroRNAs and insulin-like growth factor are two emerging biomarkers that have shown potential in helping with HF diagnosis and prognosis.

Time Spent on Medical Round Activities, Distance Walked, and Time-Motion in the General Medicine Department at Hamad General Hospital in Qatar.

Background The daily morning round is a routine activity performed by medical teams. During the morning round, updates on the patient's clinical condition, new laboratory results, and other test results are reviewed and discussed between team members, the patient, and at times the family. Completing these tasks takes time. The design of the patient location differs between hospitals, and significant distance between patients can considerably affect round times. This study assesses physicians' time spent on clinical activities, the distance traveled, and the time they spend walking between patients during daily morning rounds to identify better reorganization methods to reduce wasted time. Methodology The survey was self-administered and had no intervention needing ethical approval. The research team's leader engaged two observers (a general practitioner from another department and a general internal medicine department case manager) to collect the data. The general practitioner was a medical graduate doctor, while the bed manager was not a medical college graduate. They observed 10 rounds over 10 non-consecutive days from July 1 to July 30, 2022. They recorded daily activities during the daily morning round, including time spent with patients, family conversations, bedside education, medication, social issues, and the time and distance required to move from patient to patient and from one location to location. The informal conversations about age, work history, and other small talk were recorded and converted into quantitative data. In each round, records were given to a statistician for rechecking. Subsequently, the records were imported into a Microsoft Excel spreadsheet for further statistical analysis. For continuous variables, the data were summarized as mean, median, and standard deviation. For categorical variables, the data were summarized as counts or proportions. Results On average, the duration of the daily morning round was 161.7 ± 17.3 minutes. The average number of patients seen by the general internal medicine round team was 14. The median patient encounter time per patient was 14 minutes (11-19 minutes), with an average of 12 minutes. An average of 8.6 employees participated in the 10-day rounds. The physician spent 41.2% of the time in direct contact with the patient during the morning round, 11.4% in maintaining electronic medical records, and 18.20% in bedside teaching. Additionally, 7.1% of the round time was spent because of interruptions by clinical and non-clinical staff other than team members or family members who were not in the room. Furthermore, a team member walked an average of 763 ± 54.5 m (667-872 m) per round, costing 35.7 minutes (22.1%) of the total round time. Conclusions The daily morning round time was significantly longer compared with the reported round times. Relocating patient beds to a common location reduced the rounding time by 22.30%. Disruption, teaching, and medical instruction must also be considered and shortened to reduce the morning round time.

An Evaluation of Healthcare Safety Culture Among Healthcare Professionals in Secondary and Tertiary Public Hospitals in the Middle East Region.

Background and aim The provision of quality healthcare is initiated by a culture of patient safety. Understanding the patient safety culture (PSC) is a critical concept for all healthcare workers. We conducted this study to evaluate the PSC understanding among the Hamad Medical Corporation (HMC) staff members. Furthermore, to establish a local (HMC) reference point for providing quality health care based on a culture of patient safety. Method A Hospital Patient Safety Culture Survey (HSOPSC) was presented to our health system employees to assess their perceptions and understandings of PSC. The survey was self-administered. STATA Package version 12.0 culture software was used to analyze these data in terms of descriptive, correlational, and multivariate ordinal regression. Results This study targeted to survey 6,538 employees in HMC facilities, but only 5,583 responded, resulting in a percentage response rate of 85.4%. Ten facilities achieved 100% participation, and other HMC facilities had response rates ranging from 71.2% to 97.5%. Approximately 88.0% of the responders had direct patient contact. The HSOPSC survey resulted in an overall positive response rate of 62.4%. The dimensions with the highest positive response score were "teamwork within the Unit" followed by "organizational learning/continuous improvement" and "management support for patient safety" with a mean percent positive response (PPR) of 83.1%, 82.0%, and 79.2%, respectively. Conversely, there are three dimensions with the lowest positive response score, including "communication openness," "staffing," and "nonpunitive response to errors," with a mean PPR of 46.6%, 40.1%, and 27.7%, respectively. ANOVA and the student t-test revealed that men (64.3% ± 8.1%), employees with 11-15 years of experience in their specialty (65.8% ± 6.5%), and general hospital type (64.4% ±7.2%), were all significantly associated with differences in the overall perceptions of PSC. According to the study results, there was a moderate correlation between perceptions of PSC at the hospital and the following: Teamwork Across Units (RS= 0.43; p < 0.05), and Frequency of Events Reported (RS= 0.40; p < 0.05.). A regression analysis found that men, workers under 40 years of age, professionals with no direct contact with patients, employees with 11-15 years of experience in their specialty, intensive care staff, and general hospital staff were all significant predictors of overall favorable perceptions of the PSC. Conclusion PSC's understanding of HMC staff is moderate. Furthermore, this is the first study conducted for PSC understanding by the HMC staff in Qatar State. It is eligible to be considered a backbone and reference for new research projects about PSC in Qatari health facilities, if not worldwide.

Hepatitis A virus knowledge and immunization attitudes and practices in the United Arab Emirates community.

Annually, 1.5 million cases of hepatitis A infection occur worldwide. The United Arab Emirates (U.A.E.) has seen a decrease in infection rates and seroprevalence coupled with an increase in the average age of infection. This study aimed to assess the U.A.E. society's hepatitis A knowledge, and attitudes and vaccination practices, with the applicability of its introduction into the local immunization schedule. A self-administered, 50-item questionnaire was used to collect data from the four most populous cities in the U.A.E., between January and March 2020. A total of 458 responses were collected and analysed using IBM-SPSS-26, R-4.0.0 and Matplotlib-v3.2.1. Females had better attitudes (P = 0.036), practices (P < 0.0005), immunization schedule knowledge (AOR = 3.019; CI 1.482-6.678), and appreciation of the immunization schedule (AOR = 2.141; CI 1.310-3.499). A higher level of perceived knowledge was associated with an actual better knowledge (P < 0.0005), better practices (P = 0.011), and increased willingness to get vaccinated (AOR = 1.988; CI 1.032-3.828). Respondents were more likely to vaccinate their children against HAV if the vaccine were introduced into the National Immunization Program (P < 0.0005). Overall, disease knowledge was lacking but with positive attitudes and poor practices. There is high trust in the National Immunization Program and a potential for improving poor practices through local awareness campaigns.

[Requirements for outpatient care after implantation of a ventricular assist device : Views of patients and their relatives]. / Anforderungen an die ambulante Versorgung nach Implantation eines ventrikulären Herzunterstützungssystems : Sichtweise von Patienten und Angehörigen.

Ventricular assist device (VAD) implantation has developed into a well-established option when conservative treatment of terminal heart failure has been exhausted. Figures from 2015 make this clear: only 283 heart transplantations were performed nationwide but 959 VAD systems were implanted. It is noteworthy that the survival times with a VAD are approaching the survival times after heart transplantation. Patients with VADs have a life-long dependency on their proximity to specialists. So far, the requirements for outpatient care have not been systematically recorded from the perspective of VAD patients and their relatives. In September 2016, VAD patients (n = 30) and their relatives (n = 25) were anonymously questioned about their views on postoperative outpatient care. For this purpose, the VAD Patient Satisfaction Survey was adapted to the needs of this study. Patients with VADs and their relatives were found to experience their daily life with a VAD in a positive manner. Information, training, accessibility and regular contacts with the implantation clinic and the VAD coordinator are important pillars of outpatient care after VAD implantation. Almost 95% of surveyed patients regarded good home support as an important factor that makes life with a VAD easier. These aspects should be taken into account in the care of patients living with a VAD.

[Mechanical circulatory support in terminal heart failure]. / Die mechanische Kreislaufunterstützung in der Herzinsuffizienz.

BACKGROUND: After exhaustion of all conservative measures in the treatment of acute and chronic heart insufficiency, there is the possibility to temporarily or permanently support or replace the pump performance of the heart by mechanical circulatory support (MCS) systems. OBJECTIVE: Presentation of the most important cardiac support systems for intensive care medicine, their indications and important risk factors. MATERIAL AND METHODS: Critical review of device manufacturer's specifications, current research and expert opinions. RESULTS: The spectrum of available MCS procedures include mechanical chest compression devices, catheter-based micropumps and complete artificial hearts. Device selection depends on the severity of heart failure (monoventricular or biventricular pump failure), the expected duration of treatment and the degree of lung function impairment. The decision between minimally invasive and open surgical procedures depends on the options established at the specific healthcare institution and whether the heart function is to be temporarily or permanently replaced. Compliance with the anticoagulation regimens defined by the manufacturer is especially important as they differ vastly between devices and are critical to avoid bleeding or thromboembolic complications. CONCLUSION: Due to the increasing number of patients on long-term mechanical circulatory support, the chances are that physicians in the initial emergency admission are unfamiliar with these devices but need to operate them in emergency cases. Therefore, knowledge of these procedures and their complications becomes increasingly important.

Effects of maternal age, parity and pre-pregnancy body mass index on the glucose challenge test and gestational diabetes mellitus.

OBJECTIVES: To study the effects of age, parity and body mass index (BMI) on the incidence of a positive 50 g glucose challenge test (OGCT) and gestational diabetes mellitus (GDM) in healthy pregnant Omani women. METHODS: A 50 g OGCT was performed on 307 healthy pregnant Omani women at 24-28 weeks of gestation. When the venous plasma glucose concentration (VPG) reached >7.8 mmol/l after 1 h, the OGCT was considered to be positive. Women with positive OGCTs had a confirmatory diagnosis of GDM, which was established by performing a 2-h 75 g oral glucose tolerance test (OGTT). When either fasting or post-2-h 75 g OGTT values were >5.5 mmol/l or >8 mmol/l, respectively, women were considered diabetic. RESULTS: This study screened 307 women and identified 83 (27.03%) OGCT-positive and 23 (7.5%) GDM-positive cases. The incidences of a positive OGCT and GDM increased significantly with increasing maternal age from 20.0% to 2.2%, respectively, in women aged ≤25 years to 37.8% and 14.7%, respectively, in women aged >35 years (p = 0.02 and p = 0.009, respectively). The incidences of a positive OGCT and GDM increased markedly with increasing pre-pregnancy BMI, from 19.8% to 3.8%, respectively, in women with BMIs ≤25 kg/m2 to 37.8% and 9.9%, respectively, in women with BMIs >25 kg/m2 (p = 0.02 and p = 0.04, respectively). CONCLUSION: Maternal age and pre-pregnancy BMI have profound effects on the incidences of a positive OGCT and GDM.

A core outcome set for all types of cardiac surgery effectiveness trials: a study protocol for an international eDelphi survey to achieve consensus on what to measure and the subsequent selection of measurement instruments.

BACKGROUND: Cardiovascular disease (CVD) is a major contributor to the burden of disease and the number one cause of death worldwide. From 1990 until today, more people died from coronary heart disease than from any other cause. CVD is regularly treated with minimally or non-minimally invasive off- or on-pump cardiothoracic surgery and several interventions related to the outcome of the surgical procedures have been evaluated in clinical trials, but heterogeneity in outcome reporting hinders comparison of interventions across trials and limits the ability of research synthesis. This problem is encountered with the introduction of core outcome sets (COSs), which should be measured and reported, as a minimum, in all clinical trials for a specific clinical field. METHODS/DESIGN: This study protocol describes the methods used to develop a COS for all types of cardiac surgery effectiveness trials. We aim to reach consensus on what to measure in an international three-round eDelphi exercise involving adult patients in need or after cardiothoracic surgery, cardiothoracic surgeons, cardiologists, anaesthesiologists, nursing staff and researchers with expertise in this particular field of medical research. Subsequently, outcome measurement instruments (how to measure) will be determined. Recommendations on COS development given by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative and the Outcome Measures in Rheumatology (OMERACT) Initiative were followed. DISCUSSION: The proposed COS aims to provide methodological guidance for future cardiothoracic surgical trials to ensure the comparability of effects of interventions across studies and enable research synthesis. This does not imply that primary outcomes should always and exclusively be those of the COS. However, to ensure the comparability of results across trials, the outcomes included in this COS should be considered for inclusion besides measuring trial-specific clinical endpoints.

Spontaneous central retinal artery occlusion in a teenager with sickle cell trait.

Sickle cell trait (SCT) is traditionally considered a benign condition by ophthalmologists. Several studies have reported ocular complications in SCT, but these complications have been described as a consequence of trauma, exertion, and associated systemic disorders. We here in the report a case of an Arab teen boy, who presented with a sudden loss of vision in his left eye of 1 h duration. The ocular examination revealed acute central retinal artery occlusion. He underwent a series of laboratory and radiological investigations. The blood investigations revealed SCT and abnormal partial thromboplastin time. The fundus fluorescein angiography revealed abnormal retinal vascular perfusion. Marked blood rheological impairment and activation of the coagulation pathway can occur without any contributing factors in SCT leading to severe ocular complications. This is one of the young patients with spontaneous vascular occlusion in SCT.

Review of current technologies for thromboembolism management.

Percutaneous thrombectomy is being widely used as a sole therapy or as an adjunct to other therapies for the management of thrombotic occlusions in arteries, veins and grafts. Various techniques used can be broadly classified under percutaneous aspiration thrombectomy, pull-back thrombectomy and trapping, recirculation mechanical thrombectomy, direct contact/non-recirculation thrombectomy and direct or indirect ultrasound thrombectomy. In the following article, we will provide a review of these techniques describing the commonly utilized devices and their characteristics.

Volcano like pattern in optical coherence tomography in chronic diabetic macular edema.

In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers. This particular morphological feature at the vitreo-foveolar interface, which we name as "volcano sign", has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.

Inflammatory response in transapical transaortic valve replacement.

OBJECTIVE: Transapical aortic valve implantation (TA-AVI) has become a fast growing alternative to conventional aortic valve replacement (cAVR) particularly for patients burdened with serious comorbidities. We investigated whether the inflammatory response triggered by TA-AVI reflects the less invasive nature of this procedure. METHOD: In this prospective observational study 25 patients undergoing aortic valve replacement (AVR; 15 cAVR and 10 TA-AVI) were included. Serial plasma cytokine concentrations (IL-6, IL-8, and IL-10) were measured by commercially available enzyme-linked immunosorbent assay kits at six different time points before, during, and after surgery. RESULTS: Plasma levels of all three cytokines increased during and after both procedures and returned to baseline before the patient's discharge. Peak values of IL-6 were 258 ± 113 pg/mL in AVR patients versus 111 ± 101 pg/mL in TA-AVI patients and were reached 12 hours after surgery. For IL-8, peak values were 51 ± 29 pg/mL 1 hour after surgery in AVR patients versus 15 ± 20 pg/mL on wound closure in TA-AVI patients. Plasma levels of IL-6 and IL-8 were significantly reduced in the TA-AVI group as compared with cAVR. IL-10 is markedly activated in both groups yet its induction is more prominent in AVR patients with peak values of 51 ± 28 pg/mL for AVR versus 24 ± 18 pg/mL for TA-AVI on wound closure. CONCLUSION: TA-AVI compared with cAVR results in a significant reduction but not elimination of a systemic inflammatory response, which is attributable to cardiopulmonary bypass-dependent and bypass-independent factors.

The effects of metoprolol on hypoxia- and isoflurane-induced cardiac late-phase preconditioning.

BACKGROUND: The detrimental effects of metoprolol on early-phase preconditioning (pc) have been proven. The late phase of pc is mediated via gene transcription and cyclooxygenase-2 (COX-2) was identified as one of the key mediators. The effect of metoprolol on this is yet unknown as is its effect on cellular energy metabolism and reactive oxygen species (ROS) creation. METHODS: Cardiomyocytes from neonatal rats were cultured and randomly assigned to four pairs of treatment groups. In each pair, one group received metoprolol at a dose of 0.5 µg/ml medium. One pair served as a control; the others were subjected to 5 h of hypoxia 24 h after either hypoxia-induced, isoflurane-induced or no pc. Cell survival was measured with a redox indicator for cell metabolism. COX-2 transcription, ATP and ROS creation were measured. RESULTS: Whereas both ischemic and isoflurane pc produced mild beneficial effects (48.8±6.0% and 48.2±7.8% of surviving cells, respectively) compared with unpreconditioned controls (35.9±7.9%, P<0.01 for both), adding metoprolol was detrimental for both kinds of pc (hypoxia: 31.5±3.5%; isoflurane: 25.7±3.8%, P<0.001) but not in the unpreconditioned group (39.4±4.9%). mRNA for COX-2 was up to 10-fold elevated in pc cells. This induction was suppressed by metoprolol. Hypoxic and isoflurane-induced pc showed significant differences in ATP balance and ROS generation. CONCLUSION: Metoprolol abolishes the protection of both isoflurane- and hypoxia-induced late-phase pc in our model. This effect is accompanied by the blockade of COX-2 induction. The differences between hypoxic and isoflurane pc in ATP and ROS creation allow to presume distinct pathways on the mitochondrial level.

Heart valves from pigs and the porcine endogenous retrovirus: experimental and clinical data to assess the probability of porcine endogenous retrovirus infection in human subjects.

OBJECTIVE: Replacement of heart valves in human subjects has become a routine procedure in cardiac operations. We sought to investigate whether commercially available glutaraldehyde-fixed porcine heart valve prostheses cause porcine endogenous retrovirus infection in human subjects because recent studies revealed that human cells can be infected with porcine endogenous retrovirus. METHODS: Blood samples of 18 patients who underwent aortic or mitral valve replacement with porcine heart valves were collected 6 months to 3 years after operation and tested for porcine endogenous retrovirus by means of polymerase chain reaction and reverse transcriptase-polymerase chain reaction. In addition, we tried to trace porcine endogenous retrovirus in 3 commercially available, glutaraldehyde-fixed, porcine heart valves. RESULTS: Porcine endogenous retrovirus can be easily detected in native porcine heart valves and degrades completely within 1 week of fixation in glutaraldehyde. In all 3 commercially available porcine heart valves, no traces of porcine endogenous retrovirus were found. All blood samples showed negative test results for the porcine endogenous retrovirus genome. CONCLUSION: Our results indicate that glutaraldehyde fixation of porcine heart valves reliably prevents cross-species transmission of porcine endogenous retrovirus.

Thyroid morphometry and intrathyroidal 131-I iodine transit kinetics in Kashmiri population.

Morphometric--kinetic parameters of the thyroid gland in the Kashmiri population, which is geographically, environmentally, socioculturally, anthropologically and ethnically different from that of the main country (Indian republic), have been analysed. Morphometrically, the gland in this population has been found to be significantly larger (p less than 0.001), while kinetically, the A max which is the ordinate-extrapolate of the best-fit RAIU(t) curve, has been found to be significantly lower (p less than 0.01). The majority of other structural and functional parameters were similar to those of the north Indian population.

Effect of selective depletion of fibrinogen on the evolution of cholesterol-induced atherosclerosis in rabbits.

Atherosclerosis was produced by induced alimentary hyperlipaemia in four groups of rabbits. Animals of groups II and III received cholesterol feeds daily for 2 months while in groups IV and V this was followed by another 3 months of intermittent feeding. Group I comprised normal control rabbits. Selective fibrinogen depletion was produced in groups III and V with Arvin so as to maintain the plasma fibrinogen around 100 mg/dl over the last 2 months of cholesterol feeding. Serum lipids, blood coagulation and euglobulin clot lysis as well as the post mortem histopathology of aorta, heart, kidneys, liver and lungs did not reveal any significant differences between corresponding groups of hyperlipaemic animals treated with (groups III and V) or without (groups II and IV) Arvin. It appears that fibrinogen or fibrin incorporation does not play a significant role in the pathogenesis of atherosclerotic lesions induced in rabbits by cholesterol feeding.