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1.
J Surg Res ; 281: 338-344, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35945037

RESUMO

INTRODUCTION: Examining burden of diseases could shed light on priorities of public health interventions and research funding. This study examined trends of the U.S. top leading causes of death from 1981 to 2019 using the total number of deaths, age-adjusted death rate, and years of potential life lost (YPLLs). METHODS: Data were from the Web-based Injury Statistics Query and Reporting System. This study gathered total number of deaths, age-adjusted death rates per 100,000 people, and YPLLs under 70 y of age (YPLL-70) from 1981 to 2019 for the top 10 leading causes of death and human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) for each year. The 39 y from 1981 to 2019 were evenly divided into three study periods: 1981-1993, 1994-2006, and 2007-2019. The percent change of YPLL-70 over three time periods for the top ten leading causes of death and AIDS was calculated. Trends of age-adjusted death rates and YPLL-70 of the top five leading causes of death based on the 2018-2019 death data were also reported by graphing them against time from 1981 to 2019 to highlight major mortality causes. Age-adjusted death rates for the top five leading causes of deaths and the National Institutes of Health (NIH) annual funding level in 2019 were graphed together to illustrate funding discrepancy in injury research and prevention. RESULTS: The total number of deaths caused by malignant neoplasms in 2019 was 244,994, followed by 183,442 deaths of heart diseases, 121,476 deaths of unintentional injuries, and 41,051 suicide deaths. Despite an initial -22.20% drop of YPPL-70 during 1981-1993, unintentional injuries experienced significant increases of 19.38% and 18.59% of YPLL-70 in 1994-2006 and 2007-2019, respectively. The age-adjusted death rate for unintentional injuries was 1182 per 100,000 people in 2019, and the NIH funding in the same year was $897 million. In comparison, the age-adjusted death rate for cancer, heart disease, and human immunodeficiency virus/AIDS was 786, 649, and 30 per 100,000 people while the NIH funding was $2,560, $2,394, and $3037 million, respectively. CONCLUSIONS: Unintentional injuries, suicide, and homicide were consistently among the top leading causes of death and YPLL-70, so they should be prioritized in public health planning, research, and federal funding allocation. Injury and trauma research is severely underfunded by the U.S. premier funding agency.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Cardiopatias , Ferimentos e Lesões , Estados Unidos/epidemiologia , Humanos , Causas de Morte , Homicídio , Causalidade , Infecções por HIV/epidemiologia , Expectativa de Vida
2.
Curr Probl Cardiol ; 48(1): 101435, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36183977

RESUMO

Cardiovascular disease and cancer are the leading causes of death worldwide. With advent of novel and improved cancer therapies, a growing population of cancer patients with cardiac complications is seen. Taking this into consideration, the clinical studies have also shifted their focus from the study of a single disease to the interdisciplinary study of oncology and cardiology. This current review article provides a comprehensive review of all major articles and guidelines from the year 2021-2022 in the field of cardio-oncology.


Assuntos
Cardiologia , Doenças Cardiovasculares , Cardiopatias , Neoplasias , Humanos , Cardiotoxicidade/etiologia , Oncologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/complicações
3.
Biochim Biophys Acta Gen Subj ; 1867(1): 130264, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36273674

RESUMO

BACKGROUND: Septic shock is a serious clinical syndrome leading to high mortality. A new anti-anemia drug Roxadustat (FG-4592) protected against cardiac injury and hypertension. However, its effect and mechanism on shock and cardiac dysfunction induced by sepsis require to be investigated. METHODS: C57BL/6j mice received FG-4592 (10 mg/kg/day) by i.p injection, followed by lipopolysaccharide (LPS) or cecal ligation and puncture (CLP) treatment. Mortality and shock status were monitored during the experiment. Cardiac function was assessed using echocardiography and serum lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) assay. TEM, COX-SDH staining and ATP production were used to evaluate mitochondrial function. A non-targeted metabolomic analysis was performed to evaluate the metabolic disorders. RESULTS: Both pre- and post-treatment of FG-4592 could improve the survival rate in LPS- and CLP-induced sepsis mice with a better effect in pre-treated animals. Meanwhile, FG-4592 improved systolic blood pressure and body temperature drop in septic mice along with alleviated cardiac dysfunction (as shown by the restoration of decreased LVEF and LVFS and increased LDH and CK-MB) and inflammation. Interestingly, we observed that FG-4592 improved mitochondrial oxidative stress possibly by upregulating the anti-oxidative enzymes of SOD2 and HO-1. Furthermore, FG-4592 improved the energy supply and glycerophospholipid metabolism in cardiomyocytes, possibly through upregulating the HIF-1α-targeted genes of LDHA and PDK1 in glycolysis and CHK-α, respectively. CONCLUSIONS: FG-4592 protected against mortality and shock in septic animals possibly by antagonizing mitochondrial oxidative stress and metabolic disorders. GENERAL SIGNIFICANCE: This study provides a potential of FG-4592 as a novel drug for treating septic shock.


Assuntos
Cardiopatias , Sepse , Choque Séptico , Camundongos , Animais , Choque Séptico/tratamento farmacológico , Camundongos Endogâmicos C57BL , Lipopolissacarídeos/farmacologia , Sepse/tratamento farmacológico , Sepse/genética , Metabolismo Energético , Estresse Oxidativo
4.
Cytokine ; 161: 156048, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36279697

RESUMO

BACKGROUND: Endothelin-1 (ET-1), a potent endogenous vasoconstrictor, stimulates production of reactive oxygen species. Endothelial monocyte-activating polypeptide-II (EMAP-II) is a multifunctional polypeptide. AIM: To assess ET-1 gene polymorphism (G8002A) in pediatric patients with ß-thalassemia major (ß-TM) as a potential genetic marker for vascular dysfunction and its possible relation to EMAP II, oxidative stress and vascular complications. METHODS: ß-TM patients (n = 95) without symptomatic cardiac or renal disease were compared with 95 healthy controls. Markers of hemolysis, serum ferritin, urinary albumin-to-creatinine ratio, serum EMAP II, malondialdehyde (MDA) and antioxidant enzymes; superoxide dismutase (SOD), glutathione peroxidase (GPx), reduced glutathione (GSH), glutathione reductase and catalase were measured. ET-1 gene polymorphism (G8002A) was determined using polymerase chain reaction­restriction fragment length polymorphism. RESULTS: ß-TM patients had significantly higher EMAP II than healthy controls. EMAP II was significantly higher among patients with cardiac disease, pulmonary hypertension (PH) risk, nephropathy, poor compliance to therapy and ferritin ≥ 2500 µg/L. There were significant correlations between EMAP II and transfusion index, LDH, ferritin and oxidative stress markers. The AA genotype of ET-1 gene polymorphism (G8002A) was significantly higher among ß-TM patients than controls. The number of patients with cardiac disease, PH risk or nephropathy was significantly higher among AA genotype compared with GG and GA genotypes. Lactate dehydrogenase (LDH), serum ferritin, EMAP II, MDA, SOD and GPx were significantly higher in AA genotype. CONCLUSION: ET-1 gene polymorphism (G8002A) could be a possible genetic marker for prediction of increased susceptibility to cardiopulmonary and renal complications among pediatric patients with ß-TM.


Assuntos
Endotelina-1 , Proteínas de Ligação a RNA , Talassemia beta , Criança , Humanos , Talassemia beta/genética , Talassemia beta/complicações , Talassemia beta/terapia , Endotelina-1/genética , Ferritinas , Marcadores Genéticos , Cardiopatias/complicações , Polimorfismo Genético , Superóxido Dismutase , Nefropatias , Proteínas de Ligação a RNA/genética
5.
Physiol Rev ; 103(1): 391-432, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-35953269

RESUMO

The heart is imbued with a vast lymphatic network that is responsible for fluid homeostasis and immune cell trafficking. Disturbances in the forces that regulate microvascular fluid movement can result in myocardial edema, which has profibrotic and proinflammatory consequences and contributes to cardiovascular dysfunction. This review explores the complex relationship between cardiac lymphatics, myocardial edema, and cardiac disease. It covers the revised paradigm of microvascular forces and fluid movement around the capillary as well as the arsenal of preclinical tools and animal models used to model myocardial edema and cardiac disease. Clinical studies of myocardial edema and their prognostic significance are examined in parallel to the recent elegant animal studies discerning the pathophysiological role and therapeutic potential of cardiac lymphatics in different cardiovascular disease models. This review highlights the outstanding questions of interest to both basic scientists and clinicians regarding the roles of cardiac lymphatics in health and disease.


Assuntos
Edema Cardíaco , Cardiopatias , Vasos Linfáticos , Animais , Modelos Animais de Doenças , Edema Cardíaco/fisiopatologia , Cardiopatias/fisiopatologia , Vasos Linfáticos/fisiopatologia
6.
Rev. esp. cardiol. (Ed. impr.) ; 75(11): 936-948, nov. 2022. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-211715

RESUMO

Introducción y objetivos Se presentan los datos correspondientes a los implantes de desfibrilador automático implantable (DAI) en España en el año 2021. Métodos Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos durante el implante. Resultados En 2021 se recibieron 7.496 formularios de implante, frente a los 7.743 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations), lo que implica que se han recogido datos del 96,8% de los dispositivos implantados en España. El cumplimiento osciló entre el 99,9% en el campo «nombre del hospital implantador» y el 8,9% en la variable «hospital de referencia». En 2021, 199 hospitales han participado en el registro, lo cual supera las cifras de los años previos en que el número de participantes osciló alrededor de 170 hospitales. La tasa total de implantes registrados fue 158/millón de habitantes (163 según Eucomed), lo que la sitúa como el año con mayor actividad. Sin embargo, el registro sigue mostrando diferencias importantes entre las comunidades autónomas y la tasa de implante más baja de todos los países europeos participantes en Eucomed. Conclusione El Registro español de desfibrilador automático implantable del año 2021 recoge un incremento en el número de implantes de DAI y refleja la recuperación de la actividad hospitalaria tras el impacto inicial de la pandemia por COVID-19 durante 2020. A pesar del incremento en el número total de implantes en España, este sigue siendo muy inferior a la media de la Unión Europea y persisten las diferencias entre las comunidades autónomas españolas (AU)


Introduction and objectives This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021. Methods The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure. Results In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for “name of implanting hospital” to 8.9% for “implanting hospital”. In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed. Conclusions The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Desfibriladores Implantáveis/estatística & dados numéricos , Cardiopatias/terapia , Sistema de Registros , Sociedades Médicas , Espanha
7.
Rev. esp. cardiol. (Ed. impr.) ; 75(11): 949-959, nov. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-211716

RESUMO

Introducción y objetivos En el presente documento se recoge la actividad de estimulación cardiaca realizada en España en 2021: cifras de dispositivos, factores demográficos y clínicos, características del material implantado y datos de monitorización a distancia. Métodos Los datos se obtienen a través de la Tarjeta Europea del Paciente Portador de Marcapasos, la plataforma online CardioDispositivos.es, las bases de datos propias de los centros y los datos facilitados por los fabricantes. Resultados Se registraron 17.360 procedimientos de 95 hospitales, lo que supone el 43% de la actividad realizada. Crecieron en un 40,5% los procedimientos incluidos en CardiodioDispositivos.es. La tasa de marcapasos convencionales y resincronizadores de baja energía fue de 822 y 31 unidades/millón respectivamente y se implantaron 652 marcapasos sin cables. La media de edad al implante es avanzada (78,9 años) y el bloqueo auriculoventricular, la alteración electrocardiográfica más frecuente. Predomina el modo de estimulación bicameral, aunque para el 18,5% de los pacientes en ritmo sinusal es monocameral, fundamentalmente pacientes de más edad. Se incluyeron en programa de monitorización a distancia el 28,5% de los marcapasos y el 56,2% de los resincronizadores de baja energía. Conclusiones En 2021 aumentó el número de marcapasos convencionales en un 8,3% y el de resincronizadores, un 8,9%, a pesar del descenso de la resincronización de baja energía, probablemente atribuible al desarrollo de la estimulación del sistema de conducción. Aumentaron los marcapasos sin cables en un 25%. Continúa la expansión de la monitorización a distancia como modo fundamental de seguimiento (AU)


Introduction and objectives This document includes cardiac pacing activity performed in Spain in 2021: figures for implanted devices, demographic and clinical factors, characteristics of the implanted material, and remote monitoring data. Methods The European Pacemaker Patient Card, the CardioDispositivos.es online platform, the centers’ own databases and the data provided by the supplier companies are used as sources of information. Results 17.360 procedures were registered from 95 hospitals, which represents 43% of the activity. The implantation rates of conventional and resynchronization pacemakers were 822 and 31 units per million population, respectively. 652 leadless pacemakers were implanted. The mean age of implantation is high (78.8 years), and atrioventricular block is the most frequent electrocardiographic abnormality. Dual-chamber pacing mode predominated, nonetheless single-chamber pacing was performed in 19% of patients in sinus rhythm, mainly in the elderly. 28.5% of implanted conventional pacemakers and 56,2% of low-energy resynchronization pacemakers were included in the remote monitoring program. Conclusions In 2021 the number of conventional pacemakers increased by 8.3% and resynchronizers by 18.9%, despite the decrease in low-energy resynchronization, probably attributable to the development of physiological pacing. Leadless pacemakers increased by 25%. The expansion of remote monitoring continued, consolidating as a fundamental follow-up method (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Marca-Passo Artificial/estatística & dados numéricos , Cardiopatias/terapia , Sistema de Registros , Sociedades Médicas , Espanha
9.
J Orthop Surg Res ; 17(1): 477, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329494

RESUMO

BACKGROUND: As an important evaluation index after cervical surgery, ninety-day readmission is gradually being valued. Our study collected the latest published relevant studies, analyzed the risk factors of ninety-day readmission after cervical surgery, and continuously improved the postoperative rehabilitation plan. This study focuses on two research hotspots: (1) What is the rate of ninety-day readmission after cervical surgery? (2) What are the risk factors affecting the ninety-day readmission? METHODS: Based on the Cochrane Library, PubMed, Web of Science, and Embase databases, this study searched for studies about ninety-day readmission after cervical surgery, from the establishment of the database to August 1, 2022. The evaluation indicators are as follows: age, American Society of Anesthesiology physical status (ASA) class, diabetes, hypertension, chronic heart diseases, chronic lung diseases, income, and payments for hospitalization. The meta-analysis was performed using Review Manager 5.4. RESULTS: Seven studies with 222,490 participants were eligible for our meta-analysis. The analysis displayed that there were statistically significant differences in the age (MD = - 4.60, 95%CI - 4.89-4.31, p < 0.001), diabetes (OR = 0.60, 95%CI 0.56-0.64, p < 0.00001), hypertension (OR = 0.40, 95%CI 0.30-0.54, p < 0.00001), chronic heart diseases (OR = 0.05, 95%CI 0.01-0.19, p < 0.00001), chronic lung diseases (OR = 0.46, 95%CI 0.43-0.49, p < 0.00001), income (OR = 2.85, 95%CI 1.82-4.46, p < 0.00001), and payments for hospitalization (OR = 2.29, 95%CI 1.14-4.59, p = 0.02) between readmission and no readmission groups. In terms of the ASA, there was no difference on the ninety-day readmission (p = 0.78). CONCLUSION: Age, diabetes, hypertension, chronic heart diseases, chronic lung diseases, income, and payments for hospitalization are the risk factors of ninety-day readmission following cervical surgery.


Assuntos
Cardiopatias , Hipertensão , Pneumopatias , Humanos , Estados Unidos , Readmissão do Paciente , Fatores de Risco , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/cirurgia , Hipertensão/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
10.
Pan Afr Med J ; 42: 268, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338558

RESUMO

The current Coronavirus Disease 2019 (COVID-19) pandemic that emerged in December 2019 in China continues to claim a thousand lives worldwide. This study aimed to report characteristics and in-hospital outcomes of a Moroccan COVID-19 cohort, and identify factors which predispose patients to hospitalization and mortality from COVID-19. We conducted a cross-sectional study of symptomatic COVID-19 patients referred to COVID-19 ward of the Settat Provincial Hospital, during October 2020. A confirmed COVID-19 case was defined by a positive detection of SARS-CoV-2 genome using real-time RT-PCR assay performed on nasopharyngeal swabs. Patients´ demographic and clinical characteristics were collected and analyzed using SPSS V22.0. Univariate followed by multivariate logistic regression analysis was performed to identify factors associated with mortality due to COVID-19. In total, 269 patients were reported. The median age was 64 years [IQR 54-73], 48.7% were elderly (≥ 65 years), 51.7% were men, and the case-fatality rate (CFR) was 5.58%. Males had a higher CFR (6.5%) than females (4.6%). In deceased people: 60% males, 73.3% were elderly, and oxygen saturation values of 90% or less on admission were more frequent (86.7%) than in recovered ones (10.9%). Most patients (80.3%) had at least one comorbidity: 100% of deaths, 59% older than 60 years, CFR was 6.94% and the most prevalent diseases were diabetes (54.6%), hypertension (41.7%), and cardiac disease (40.7%). The most common symptoms on presentation were dyspnea (67.7%), fever (65.4%) and cough (58.4%). Multivariable logistic regression analysis showed that only older age (AOR: 10.860, 95% CI: 3.382-34.86; p<0.001) and cardiac disease (AOR: 0.244, 95% CI: 0.074-0.799; p=0.02) were associated with higher mortality rates. Categorizing patients at admission according to risk factors identified by multivariate and also univariate analyses (mainly dyspnea) is essential to help in deciding the hospitalization priority and the strategy that will eventually reduce death risk.


Assuntos
COVID-19 , Cardiopatias , Masculino , Feminino , Humanos , Idoso , Pessoa de Meia-Idade , COVID-19/diagnóstico , SARS-CoV-2 , Estudos Transversais , Marrocos/epidemiologia , Hospitalização , Comorbidade , Fatores de Risco , Estudos Retrospectivos , Dispneia , Hospitais , Demografia
11.
BMJ Case Rep ; 15(11)2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328361

RESUMO

A man in his 50s with sudden-onset left-sided subcostal pain was diagnosed with splenic infarction by thoracoabdominal CT with contrast enhancement, which also revealed a mural thrombus in the thoracoabdominal aorta, raising the possibility of aortic dissection. The electrocardiographic findings were normal and transthoracic echocardiography did not detect thrombus in the heart. Antihypertensive medication was administered on admission, and anticoagulation therapy was started after he developed left renal infarction and occlusion of the superior mesenteric artery. Nevertheless, he subsequently sustained an acute cerebral infarction. Transoesophageal echocardiography revealed an abnormal floating structure in the ascending aorta, which was surgically removed and finally diagnosed as an organising thrombus. Although most of the causes of multiorgan infarction are cardiogenic, floating mural thrombus can also be a cause. Anticoagulation therapy may be necessary for patients with recurring severe embolisms even when aortic dissection has not been completely ruled out.


Assuntos
Aneurisma Dissecante , Doenças da Aorta , Cardiopatias , Infarto do Miocárdio , Tromboembolia , Trombose , Masculino , Humanos , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Trombose/complicações , Trombose/diagnóstico por imagem , Aorta/diagnóstico por imagem , Tromboembolia/complicações , Infarto do Miocárdio/diagnóstico , Cardiopatias/complicações , Anticoagulantes/uso terapêutico , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem
12.
J Med Internet Res ; 24(11): e40364, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36322107

RESUMO

BACKGROUND: Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode. OBJECTIVE: This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases. METHODS: A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots. RESULTS: A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate. CONCLUSIONS: This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.


Assuntos
Diabetes Mellitus , Cardiopatias , Hipertensão , Telemedicina , Telerreabilitação , Humanos , Qualidade de Vida , Vida Independente , Papel do Profissional de Enfermagem , Doença Crônica
14.
BMC Health Serv Res ; 22(1): 1391, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36419153

RESUMO

BACKGROUND: Internationally, stroke and cardiac rehabilitation clinicians agree that current cardiac rehabilitation models are a suitable secondary prevention program for people following a transient ischaemic attack (TIA) or mild stroke. There is strong evidence for exercise-based cardiac rehabilitation in people with heart disease, however, the evidence for cardiac rehabilitation post-TIA or stroke is limited. Here we will explore the effectiveness and implementation of an integrated (TIA, mild stroke, heart disease) traditional exercise-based cardiovascular rehabilitation (CVR) program for people with TIA or mild stroke over 6-months. METHODS: This type 1 effectiveness-implementation hybrid study will use a 2-arm single-centre assessor-blind randomised controlled trial design, recruiting 140 participants. Adults who have had a TIA or mild stroke in the last 12-months will be recruited by health professionals from hospital and primary healthcare services. Participants will be assessed and randomly allocated (1:1) to the 6-week CVR program or the usual care 6-month wait-list control group. Distance completed in the 6-min walk test will be the primary effectiveness outcome, with outcomes collected at baseline, 6-weeks (complete CVR) and 6-months in both groups. Other effectiveness outcome measures include unplanned cardiovascular disease-related emergency department and hospital admissions, daily minutes of accelerometer moderate-to-vigorous physical activity, body mass index, waist circumference, blood pressure, quality of life, anxiety and depression. Implementation outcomes will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, including a cost-effectiveness analysis. Semi-structured interviews will be conducted with participants and CVR program health professionals, investigating the acceptability, value, and impact of the CVR program. Qualitative analyses will be guided by the Consolidated Framework for Implementation Research. DISCUSSION: Few studies have assessed the effectiveness of cardiac rehabilitation for people with TIA and mild stroke, and no studies appear to have investigated the cost-effectiveness or implementation determinants of such programs. If successful, the CVR program will improve health outcomes and quality of life of people who have had a TIA or mild stroke, guiding future research, policy, and clinical practice, reducing the risk of repeat heart attacks and strokes for this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621001586808 , Registered 19 November 2021.


Assuntos
Reabilitação Cardíaca , Cardiopatias , Ataque Isquêmico Transitório , Infarto do Miocárdio , Acidente Vascular Cerebral , Adulto , Humanos , Qualidade de Vida , Austrália , Acidente Vascular Cerebral/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Front Immunol ; 13: 974826, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36420265

RESUMO

Systemic lupus erythematosus (SLE) patients display an increased risk of cardiovascular disease (CVD). With the improved clinical management of other classical severe manifestation of the disease, CVD is becoming one of the most relevant complications of SLE, and it is an important factor causing morbidity and mortality. Several immune constituents have been shown to be involved in the pathogenesis of atherosclerosis and endothelial damage in SLE patients, including specific circulating cell populations, autoantibodies, and inflammatory mediators. In this review, we summarize the presentation of CVD in SLE and the role of the autoimmune responses present in SLE patients in the induction of atherogenesis, endothelial impairment and cardiac disease. Additionally, we discuss the utility of these immune mediators as early CVD biomarkers and targets for clinical intervention in SLE patients.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Cardiopatias , Lúpus Eritematoso Sistêmico , Humanos , Doenças Cardiovasculares/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Biomarcadores , Aterosclerose/etiologia
16.
Arch Cardiol Mex ; 92(4): 446-453, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413696

RESUMO

OBJECTIVE: The myocardial efficiency index (MEI) correlates the Myocardial Oxygen Consumption (MVO2) with the Maximum Oxygen Consumption (VO2max), this index provides information about the cardiovascular efficiency (CVEf). In athletes, the MEI improves after a micro-cycle training, however in patients with cardiovascular disease undergoing Cardiac Rehabilitation Program (CRP), IEM behavior could be a good estimator related to the improvement training period. The objective of this study was to determine the myocardial efficiency index behavior in patients with heart disease and high cardiovascular risk (HCVR) after a CRP. METHODS: Ambilective, descriptive, analytical, non-randomized cohort study was conducted. Patients with heart disease of mixed etiology and HCVR admitted to a CRP for 4-6 weeks were selected. All patients performed a maximal exercise test in band before and after the CPR. Thresholds of VO2 peak, METs-load, Double product (DP) and MEI were determined. A cut-off point for the MEI was established using a ROC curve with a value of 7.37, area under the curve: 0.68 (95% CI 0.61 - 0.76, p < 0.001), sensitivity 0.60 and 1-specificity 0.35. RESULTS: 193 patients with a mean age of 62.3 years were included, predominantly men (66.2%). Percentages changes in the MEI-27.1% (p < 0.001),METs-43.1% (p < 0.001),DP 5.7% (p < 0.01), and MVO2: 8.3% (p < 0.01) were observed at the end of CRP. CONCLUSIONS: Significant change in the MEI were observed after CRP associated to CVEf improvement, suggesting that this parameter could be considered as a good clinical tool in the CRP care programs.


OBJETIVO: El índice de eficiencia miocárdica (IEM) correlaciona el consumo miocárdico de oxígeno (MVO2) con el consumo máximo de oxígeno, el cual proporciona información sobre la eficiencia cardiovascular (EfCV). En deportistas, el IEM mejora posterior a un microciclo de entrenamiento, en el paciente con enfermedad cardiovascular sometido a un programa de rehabilitación cardiaca y prevención secundaria PRHCyPS, el comportamiento del IEM podría resultar un estimador relacionado con mejoría derivado de un periodo de entrenamiento. El objetivo del estudio fue determinar el comportamiento del IEM posterior a un PRCyPS en pacientes con cardiopatías y riesgo cardiovascular alto (RCVA). MÉTODOS: Estudio de cohorte ambilectivo, descriptivo, analítico, no aleatorizado. Se seleccionaron pacientes con cardiopatías de etiología mixta con RCVA ingresados a un PRCyPS durante 4-6 semanas. A todos los pacientes se les realizó una prueba de ejercicio máximo en banda antes y después del PRCyPS. Se determinaron umbrales de consumo de oxígeno (VO2) pico, equivalentes metabólicos-carga, doble producto e IEM. Se estableció un punto de corte del IEM mediante una curva ROC con un valor de 7.37 con un área bajo la curva de 0.68 (IC 95%: 0.61-0.76; p < 0.001), sensibilidad 0.60 y 1-especificidad de 0.35. RESULTADOS: Se incluyeron 193 pacientes con una media de edad de 62.3 años, en su mayoría del sexo masculino (66.2%). Se observaron porcentajes de cambio en el IEM ­27.1% (p < 0.001), MET 43.1% (p < 0.001), doble producto 5.7% (p < 0.01) y MVO2: 8.3% (p < 0.01) al término del PRCyPS. CONCLUSIONES: Se observó un cambio significativo en el IEM posterior a un PRCyPS, lo cual se asoció a una mejoría en la EfCV, sugiriendo que este pueda considerarse como un parámetro clínico que evaluar en los programas de rehabilitación cardiaca.


Assuntos
Reabilitação Cardíaca , Cardiopatias , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Estudos de Coortes , Miocárdio , Teste de Esforço
18.
Sci Rep ; 12(1): 20012, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36411366

RESUMO

Chronic kidney disease (CKD) and heart failure (HF) are the first and most frequent comorbidities associated with mortality risks in early-stage type 2 diabetes mellitus (T2DM). However, efficient screening and risk assessment strategies for identifying T2DM patients at high risk of developing CKD and/or HF (CKD/HF) remains to be established. This study aimed to generate a novel machine learning (ML) model to predict the risk of developing CKD/HF in early-stage T2DM patients. The models were derived from a retrospective cohort of 217,054 T2DM patients without a history of cardiovascular and renal diseases extracted from a Japanese claims database. Among algorithms used for the ML, extreme gradient boosting exhibited the best performance for CKD/HF diagnosis and hospitalization after internal validation and was further validated using another dataset including 16,822 patients. In the external validation, 5-years prediction area under the receiver operating characteristic curves for CKD/HF diagnosis and hospitalization were 0.718 and 0.837, respectively. In Kaplan-Meier curves analysis, patients predicted to be at high risk showed significant increase in CKD/HF diagnosis and hospitalization compared with those at low risk. Thus, the developed model predicted the risk of developing CKD/HF in T2DM patients with reasonable probability in the external validation cohort. Clinical approach identifying T2DM at high risk of developing CKD/HF using ML models may contribute to improved prognosis by promoting early diagnosis and intervention.


Assuntos
Diabetes Mellitus Tipo 2 , Cardiopatias , Insuficiência Cardíaca , Falência Renal Crônica , Insuficiência Renal Crônica , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Estudos Retrospectivos , Insuficiência Renal Crônica/diagnóstico , Aprendizado de Máquina
19.
Ital J Pediatr ; 48(1): 187, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36411466

RESUMO

BACKGROUND: Pompe disease is a rare autosomal recessive disease. Acid alpha-glucosidase (GAA) deficiency leads to glycogen storage in lysosomes, causing skeletal, cardiac, and smooth muscle lesions. Pompe disease is progressive, and its severity depends on the age of onset. Classic infantile Pompe disease, the most severe form, is characterized by an age of onset before 12 months. Pompe disease with intrauterine onset has rarely been reported. CASE PRESENTATION: The proband was born at a gestational age of 40 weeks and 3 days and admitted to our hospital because of intrauterine cardiac hypertrophy, shortness of breath, and cyanosis until 13 min postnatally. Physical examination at admission revealed poor responsiveness, pale skin, shortness of breath, reduced limb muscle tone, and bilateral pedal edema. The heart sounds were weak, and no heart murmur was heard. Echocardiography showed left (9 mm) and right (5 mm) ventricular hypertrophies. The patient was subjected to non-invasive ventilator-assisted respiration, fluid restriction, diuresis, and metoprolol treatment. Infantile Pompe disease was diagnosed on day 16 with a GAA enzymatic activity of 0.31 µmol/L/h and with the full-penetrance genetic test showing the homozygous gene mutation c.1844G>T(p.Gly615Val). Enzyme replacement therapy was refused by the patient's parents, and the patient died at seven months of age from cardiopulmonary failure. CONCLUSION: Infants with intrauterine-onset Pompe disease usually have early manifestations of heart disease. Prompt GAA enzymatic activity determination and molecular genetic testing are helpful in aiding the parents' decision and planning the treatment.


Assuntos
Doença de Depósito de Glicogênio Tipo II , Cardiopatias , Lactente , Humanos , Doença de Depósito de Glicogênio Tipo II/complicações , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Doença de Depósito de Glicogênio Tipo II/genética , Terapia de Reposição de Enzimas , Dispneia , Cianose
20.
Biomed Pharmacother ; 156: 113935, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36411622

RESUMO

Heart-related diseases account for a high proportion of deadly pathologies, so a large number of studies have been conducted to discover potential biomarkers for the early detection of heart disease. Circular RNAs (circRNAs) are known to be involved in various human diseases, and several circRNAs associated with heart disease have been reported recently. However, there is a lack of literature summarizing the potential of circRNAs as biomarkers of heart disease and suggesting future research prospects. In this review, the history of circRNA research and important studies on circRNAs are described. In addition, the biogenesis process of circRNAs and the applicability of circRNA as a biomarker of heart disease are introduced, and select studies that monitored circRNAs circulating in human blood as biomarkers of heart disease are summarized. The contents of this review may help the researchers interested in the detection and prevention of heart disease at an early stage.


Assuntos
Cardiopatias , RNA Circular , Humanos , RNA Circular/genética , Biomarcadores , Cardiopatias/diagnóstico , Cardiopatias/genética , Previsões
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