Triglyceride-Glucose Index as Predictor for Hypertension, CHD and STROKE Risk among Non-Diabetic Patients: A NHANES Cross-Sectional Study 2001-2020.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of global mortality. Early intervention and prevention of CVD depend on accurately predicting the risk of CVD. This study aimed to investigate the association between the TyG index and the risk of coronary heart disease (CHD), congestive heart failure (CHF), heart attack (HA), stroke, and hypertension (HTN) among patients without diabetes in the United States. METHODS: In this retrospective, cross-sectional study, we used data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020. We conducted several regression analysis models and calculated the sensitivity and specificity of (TyG) index for predicting the onset of CHD, CHF, HA, stroke, and HTN. RESULTS: A total of 10,937 individuals without diabetes participated in our study. Individuals with a TyG index greater than 8.96 displayed significant increasing in various parameters, including BMI, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p < 0.001). Almost all regression models ensured that a higher TyGI value was associated with higher odds of having CHD, CHF, HA, stroke, and HTN, which patients with a TyGI value higher than 8.96 have odds ratios of 2.24-5.58 for CHD, 1.68-4.42 for stroke, 2.45-3.77 for HA and 1.75-3.93 for HTN comparing than patients with a TyGI value lower than 8.11 (p-value < 0.05).We evaluated the predictive value of the TyG index for each endpoint, obtaining the following area under the curve (AUC) values: 54.75% for CHF (95% CI: 0.542-0.614), 52.32% for stroke (95% CI: 0.529-0.584), 55.67% for HA (95% CI: 0.595-0.646), 55.59% for HTN (95% CI: 0.574-0.597), and 50.31% for CHD (95% CI: 0.592-0.646). CONCLUSION: The TyG index showed a strong correlation with cardiovascular risk factors in individuals without diabetes, however it was a poor predictor of almost studied cardiovascular diseases.

Impact of right ventricular dysfunction on outcomes in patients requiring intra-aortic balloon pump placement: A retrospective nationwide analysis (2016-2020).

Right ventricular dysfunction (RVD) continues to be a significant contributor to both mortality and morbidity, posing a significant challenge in the management of patients undergoing evaluation for mechanical circulatory support (MCS). Currently, there is a paucity of data regarding outcomes in this subset of patients. We analyzed the National Inpatient Sample database (NIS) to identify adult hospitalizations who underwent intra-aortic balloon pump (IABP) placement with or without co-existence of RVD. Multivariate logistic regression, and linear regression analyses were used to compare outcomes, and adjust for possible confounders. Out of 126,985 hospitalizations who underwent IABP placement, 1,475 (1.2%) had RVD. Patients with RVD who received an IABP had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 2.33, 95% confidence interval [CI]: 1.7-3.2, p<0.001) than those without co-existing RVD. Hospitalized patients who underwent IABP placement with RVD had higher adjusted odds of worse hospitalization outcomes in general. Conducting additional prospective studies and clinical trials with an emphasis on further subcategorization of patients with RVD is crucial for determining optimal management strategies for these patients.

Impact of Co-existing Paroxysmal Atrial Fibrillation on Different Outcomes of Hospitalized COVID-19 Patients: Nationwide Inpatient Sample Analysis (2020) With Propensity Score Matching.

Various studies in the medical literature reported significant cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) pneumonia. Atrial fibrillation (AF) was identified as the most commonly observed arrhythmia complicating COVID-19 infection with an increased risk of short-term mortality. We used the National Inpatient Sample Database (NIS) of 2020 to conduct this retrospective cohort study. Our study's population consisted of adult patients hospitalized for COVID-19 Pneumonia with or without the presence of paroxysmal atrial fibrillation (PAF). Encounters with COVID-19 and co-existing PAF had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 1.19, 95% CI: 1.11-1.28, P < 0.001), longer mean length of hospital stay (LOS) of 1.17 days (95% confidence interval [CI]: 1.03-1.38, P < 0.001), and higher odds of different in-hospital complications. Based on these results, conducting more prospective/retrospective cohort studies with an emphasis on long-term follow-up on patients who develop PAF following COVID-19 infection is warranted.

Syrians' awareness of cardiovascular disease risk factors and warning indicators: a descriptive cross-sectional study.

The awareness of cardiovascular diseases (CVDs) contributes to the complications and fatality rates from these diseases among individuals; however, no previous study in Syria was conducted on this topic; thus, this study aims to assess Syrians' awareness of CVDs warning symptoms and risk factors. This online cross-sectional study was performed in Syria between the 1st and 25th of August 2022. The inclusion criteria for the sample were citizens of Syria over 18 who currently reside in Syria. The questionnaire included open- and closed-ended questions to assess the awareness of CVDs. A total of 1201 participants enrolled in the study with a response rate of 97.2%; more than half of the participants (61.4%) were aged 18-24. The most recognizable risk factors and warning signs when asking close-ended and open-ended questions were smoking (95.2%, 37.1%) and chest pain (87.8%, 24.8%), respectively. Overall knowledge scores for risk factors and warning signs were (61.5%). Regarding knowledge score of CVDs risk factors and warning signs, participants aged 45-54 scored higher than other age groups, and respondents with a university education level had a higher score than other educational levels (15.7 ± 0.3), (14.5 ± 0.1), respectively. Participants aged 45-54 have a higher probability of good knowledge of CVDs risk factors and warning signs than participants aged 18-24 (OR = 4.8, P value < 0.001), while participants living in the countryside were less likely to have good knowledge of CVDs risk factors and warning signs than city residents (OR = 0.6, P value < 0.05). According to our results, there is inadequate knowledge of the risk factors and warning signs of CVDs. Consequently, there is a greater need to raise CVD awareness and learning initiatives on the disease's risk factors and symptoms.

Assessment the awareness toward hypertension and diabetes mellitus: Syrian cross sectional study.

BACKGROUND: Diabetes and arterial hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population's knowledge and treatment of hypertension and diabetes. It is crucial to investigate how the Syrian public understands and perceives these disorders in order to address the increased incidence and prevalence of hypertension and diabetes. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals. METHODS: A cross-sectional survey was conducted online between 1 August and 25 August 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. The survey consisted four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents' knowledge of and comprehension of hypertension and diabetes, and respondents' awareness of these disorders. RESULTS: Among 976 participants, 65.8% were females. the most common causes for hypertension from the perspective of participants were (90.1%) for stress, (87%) High salt consumption, (82.1%) genetics, (78.2%) old age, (78%) obesity (69%) anxiety, and (38.6%) for drug usage. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. There was a statistical significant difference between the knowledge toward the hypertension and the drinking alcohol, which the nonalcoholic knowledgeable persons were the most common (819 / 976)(P < 0.05). Participants whose lifestyles did not include alcohol use had a higher hypertension knowledge level (90.3%). Participants who do not consume alcohol have shown better hypertension knowledge (90.3%) than those who do (81.9%). Almost age groups have shown good knowledge of diabetes, especially participants aged above 55 (93.8%). However, most individuals have examined blood pressure (82.3%), whereas fewer than half had screened for blood sugar (64.4%). About 82.2% of individuals check their blood pressure frequently, whereas 6.2% monitor their blood sugar. There were significant associations between hypertension knowledge and gender, education, employment, and economic position (P value < 0.05). Men (mean = 8.39, SD = 2.02, P-value < 0.05) have a higher hypertension knowledge than females, and knowledge of hypertension among participants was shown to be higher among those in good income status than other economic levels (mean = 8.34, SD = 1.98). Age, gender, education, employment, and marital status were all associated with diabetes knowledge. Participants between the ages of 40 and 55 showed better knowledge of diabetes compared to other age groups (mean = 11.32, SD = 2.54); also, men demonstrated greater knowledge of diabetes than females (mean = 10.76, SD = 2.79). CONCLUSION: We indicated that the Syrian population has a good to moderate understanding of hypertension and diabetes. However, there is still a shortage of standardized, regular screening practices. Since individuals remain involved in unhealthy lifestyle habits, it is vital to provide accurate information about hypertension and diabetes to encourage them to make healthy changes.

Anteriolateral versus anterior-posterior electrodes in external cardioversion of atrial fibrillation: A systematic review and meta-analysis of clinical trials.

The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta-analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior-lateral with anterior-posterior electrodes in external cardioversion of AF. After the full-text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior-lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02-1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior-lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17-2.54, p = .006), (OR = 1.73, 95% CI = 1.18-2.54, p = .005), and (OR = 1.86, 95% CI = 1.04-3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior-posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm.

Relation Between Familial Mediterranean Fever and QT Markers (QTc, QTd, and QTcd): A Systematic Review and Meta-Analysis.

The aim of this study is to perform a meta-analysis to evaluate the possible association betweenQT markers and familial Mediterranean fever (FMF). PUBMED, Web of Science, OVID, and SCOPUS databases were searched. Inclusion criteria were randomized control trials or observational studies that compared measurement of the QT markers in FMF patients and healthy controls in both males and females without any age restriction or other comorbidities. RevMan software (5.4) was used to perform the analysis. A total of 14 studies with 1,154 individuals were included in the study. The pooled effect estimate showed a statistically significant association between FMF group and prolonged corrected QT (QTc) and QT dispersion (QTd) (MD= 7.06, 95% CI = 2.68 to 11.43, p-value = 0.002) and (MD= 6.08, 95% CI = 0.84 to 11.32, p-value= 0.02), respectively. No statistically significant difference between FMF group and QT interval and corrected QT dispersion (QTcd) (MD= 2.34, 95% CI = -1.21 to 5.89, p-value = 0.20) and (MD= 4.82, 95% CI = -0.57 to 10.20, p-value = 0.08), respectively. Our findings revealed a statistically significant relationship between FMF and extended QTc and QTd. More randomized multicenter trials are required to confirm our findings.

The significance of upright T wave in lead V1 in predicting myocardial ischemia A literature review.

Chest pain is still representing one of the most common and serious presentations to the emergency department worldwide. ECG is a crucial tool in evaluating patients with chest pain; however, only around 50% of patients with acute coronary syndrome (ACS) will have a diagnostic ECG upon their presentation; the rest may either have a completely normal ECG or what is called nonspecific ST segment and T wave (NSSTTW) changes, hence it is essential to recognize the subtle ECG changes and know its significance. One of the ECG changes that can be easily missed is when the T wave in V1 is upright, especially when it is either a Tall Upright T wave (TTV1) or a New Tall Upright T-wave (NTTV1). Although upright T wave in lead V1 can be a normal variant, it has been linked in a few studies and observations to cardiovascular disease, especially myocardial ischemia. In this article, we are trying to highlight the importance of this subtle ECG change in predicting cardiovascular disease through a concise review of the available evidence on this topic.

Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score.

BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. METHODS: We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. RESULTS: The cases examined for the determination of DILI avoidability had probability likelihood of "probable" or "highly probable" by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as "avoidable" ("probable" or "definite") by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf's kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. CONCLUSION: We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients.