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1.
Cardiovasc Diabetol ; 19(1): 164, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004045

RESUMO

BACKGROUND: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10). CONCLUSIONS: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/metabolismo , Infecções por Coronavirus/metabolismo , Diabetes Mellitus/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/metabolismo , Pessoa de Meia-Idade , Multimorbidade/tendências , Pandemias , Pneumonia Viral/metabolismo , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Medicina (B Aires) ; 80(5): 425-432, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048784

RESUMO

The COVID-19 pandemic has led to measures of social isolation, labor restrictions, a strong information campaign and the suspension of scheduled medical activities. The aim of this study was to describe the impact of these measures on the number of hospitalizations in Cardiovascular Intensive Care Units, with the hypothesis that the social behavior generated by this emergency promotes a decreased demand for medical care, even when severe cardiovascular disease is involved. We compared the number of admissions in March-April 2010-2019 versus March-April 2020, based on a prospective study including six institutions (three public and three private) that use Epi-Cardio® as a multicenter registry of cardiovascular care unit discharge. Altogether, we included 6839 patients discharged during the 11-year study period (2010-2020). The average number of patient admissions on March-April 2010-19 was 595 (CI 95%: 507-683) and decreased to 348 in 2020 (fall of 46.8%, p < 0.001). The reasons for hospitalization were classified into 11 groups and a statistically significant reduction was seen in 10 of these groups: cardiovascular surgery 72.3%, electrophysiological interventions 67.8%, non-ST acute coronary syndromes 52.6%, angioplasties 47.6%, arrhythmias 48.7%, heart failure 46%, atrial fibrillation 35.7%, ST elevation myocardial infarction 34.7%, non cardiac chest pain 31.8%, others 51.6%. Although with low prevalence, hypertensive crisis increased in 89%. The abrupt decrease observed in the number of admissions due to critical pathologies may be considered an "adverse effect" related to the measures adopted, with potentially severe consequences. This trend could be reversed by improving public communication and policy adjustment.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral , Argentina/epidemiologia , Betacoronavirus , Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Estudos Prospectivos
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 918-922, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018134

RESUMO

Synthesis of accurate, personalize photoplethysmogram (PPG) signal is important to interpret, analyze and predict cardiovascular disease progression. Generative models like Generative Adversarial Networks (GANs) can be used for signal synthesis, however, they are difficult to map to the underlying pathophysiological conditions. Hence, we propose a PPG synthesis strategy that has been designed using a cardiovascular system, modeled through the hemodynamic principle. The modeled architecture is composed of a two-chambered heart along with the systemic-pulmonic blood circulation and a baroreflex auto-regulation mechanism to control the arterial blood pressure. The comprehensive PPG signal is synthesized from the cardiac pressure-flow dynamics. In order to tune the modeled cardiac parameters with respect to a measured PPG data, a novel feature extraction strategy has been employed along with the particle swarm optimization heuristics. Our results demonstrate that the synthesized PPG is accurately followed the morphological changes of the ground truth (GT) signal with an RMSE of 0.003 occurring due to the Coronary Artery Disease (CAD) which is caused by an obstruction in the artery.


Assuntos
Doenças Cardiovasculares , Modelos Cardiovasculares , Pressão Arterial , Doenças Cardiovasculares/diagnóstico , Humanos , Fotopletismografia , Processamento de Sinais Assistido por Computador
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2788-2791, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018585

RESUMO

In this paper, we explored the link between sleep apnoea and cardiovascular disease (CVD) using a time-series statistical measure of sleep apnoea-related oxygen desaturation. We compared the performance of a hypoxic measure derived from the polysomnogram with the Apnoea Hypopnoea Index (AHI) in predicting CVD mortality in patients of the Sleep Heart Health Study.We estimated the relative cumulative time of SpO2 below 90% (Tr90) using pulse oximetry signals from polysomnogram recordings as the hypoxic measure of desaturation patterns. Then, the survival curves for hypoxia quintiles were evaluated for the prediction of CVD mortality and were compared with the results using AHI for prediction. We also calculated the Cox hazard ratios for Tr90 and AHI. Our results show that the Tr90 was a better predictor of CVD mortality outcomes than AHI.


Assuntos
Doenças Cardiovasculares , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Doenças Cardiovasculares/diagnóstico , Humanos , Oxigênio , Polissonografia , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico
5.
Int J Mol Sci ; 21(18)2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32947927

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19), an infectious disease with severe acute respiratory syndrome, has now become a worldwide pandemic. Despite the respiratory complication, COVID-19 is also associated with significant multiple organ dysfunction, including severe cardiac impairment. Emerging evidence reveals a direct interplay between COVID-19 and dire cardiovascular complications, including myocardial injury, heart failure, heart attack, myocarditis, arrhythmias as well as blood clots, which are accompanied with elevated risk and adverse outcome among infected patients, even sudden death. The proposed pathophysiological mechanisms of myocardial impairment include invasion of SARS-CoV-2 virus via angiotensin-converting enzyme 2 to cardiovascular cells/tissue, which leads to endothelial inflammation and dysfunction, de-stabilization of vulnerable atherosclerotic plaques, stent thrombosis, cardiac stress due to diminish oxygen supply and cardiac muscle damage, and myocardial infarction. Several promising therapeutics are under investigation to the overall prognosis of COVID-19 patients with high risk of cardiovascular impairment, nevertheless to date, none have shown proven clinical efficacy. In this comprehensive review, we aimed to highlight the current integrated therapeutic approaches for COVID-19 and we summarized the potential therapeutic options, currently under clinical trials, with their mechanisms of action and associated adverse cardiac events in highly infectious COVID-19 patients.


Assuntos
Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Antivirais/farmacologia , Antivirais/uso terapêutico , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Doenças Cardiovasculares/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Genoma Viral , Humanos , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Pneumopatias/mortalidade , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Sistema Renina-Angiotensina , Replicação Viral/efeitos dos fármacos
6.
Lancet Public Health ; 5(10): e543-e550, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32979305

RESUMO

BACKGROUND: To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. METHODS: We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. FINDINGS: Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, -18·1 to 36·6) during this time period was not statistically significant. INTERPRETATION: In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. FUNDING: National Institute of Health Research.


Assuntos
Infecções por Coronavirus/epidemiologia , Diagnóstico , Pandemias , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/diagnóstico , Transtornos Cerebrovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Modelos Estatísticos , Neoplasias/diagnóstico , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
8.
J Stroke Cerebrovasc Dis ; 29(8): 104949, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32927523

RESUMO

BACKGROUND: We conducted a systematic review and meta-analysis to evaluate the latest evidence on the association between cerebrovascular, and cardiovascular diseases and poor outcome in patients with Coronavirus Disease 2019 (COVID-19) pneumonia. METHODS: A comprehensive systematic literature search was performed using PubMed, SCOPUS, EuropePMC, and Cochrane Central Database. The outcome of interest was composite poor outcome that comprised of mortality and severe COVID-19. RESULTS: A total of 4448 patients were obtained from 16 studies. Cerebrovascular disease was associated with an increased composite poor outcome (RR 2.04 [1.43,2.91], p<0.001; I2: 77%). Subgroup analysis revealed that cerebrovascular disease was associated with mortality (RR 2.38 [1.92,2.96], p<0.001; I2: 0%) and showed borderline significance for severe COVID-19 (RR 1.88 [1.00,3.51], p = 0.05; I2: 87%). Cardiovascular disease was associated with increased composite poor outcome (RR 2.23 [1.71,2.91], p<0.001; I2: 60%), mortality (RR 2.25 [1.53,3.29], p<0.001; I2: 33%) and severe COVID-19 (RR 2.25 [1.51,3.36], p<0.001; I2: 76%). Meta-regression demonstrate that the association was not influenced by gender, age, hypertension, diabetes, and respiratory comorbidities. Furthermore, the association between cerebrovascular disease and poor outcome was not affected by cardiovascular diseases and vice versa. CONCLUSION: Cerebrovascular and cardiovascular diseases were associated with an increased risk for poor outcome in patients with COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Doenças Cardiovasculares/mortalidade , Transtornos Cerebrovasculares/mortalidade , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Causas de Morte , Transtornos Cerebrovasculares/diagnóstico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Nível de Saúde , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
9.
PLoS One ; 15(9): e0236277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877424

RESUMO

Patients with high serum ferritin and low transferrin saturation (TSAT) levels could be considered as presenting with dysutilization of iron for erythropoiesis. However, the long-term safety of iron administration in these patients has not been well established. An observational multicenter study was performed over 3 years. In 805 patients undergoing maintenance hemodialysis (MHD), we defined dysutilization of iron for erythropoiesis in patients with lower TSAT (<20%) and higher ferritin (≥100 ng/mL) levels. A time-dependent Cox hazard model was used for the evaluation of the association between dysutilization of iron for erythropoiesis and adverse events and survival. Patients with low TSAT levels showed an increased risk of cerebrovascular and cardiovascular disease (CCVD) and death compared to patients with normal or higher TSAT levels. Patients with low ferritin and high TSAT levels had a significantly lower risk of CCVD and death compared with patients with high ferritin and low TSAT levels. Higher TSAT levels were associated with male gender, age, the absence of diabetes, low levels of high-sensitivity CRP, and low ß2 microglobulin levels, but not with intravenous iron administration or ferritin levels. Although patients with low TSAT levels had a significantly higher risk of CCVD or death, high TSAT levels were not linked with iron administration. Patients, who were suspected of dysutilization of iron for erythropoiesis, had a higher risk of CCVD and death. The administration of iron should be performed cautiously for improving TSAT levels, as iron administration could sustain TSAT levels for a short term.


Assuntos
Doenças Cardiovasculares/sangue , Transtornos Cerebrovasculares/sangue , Ferritinas/sangue , Diálise Renal , Transferrina/análise , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/etiologia , Feminino , Humanos , Ferro/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Diálise Renal/efeitos adversos , Fatores de Risco
10.
J Cardiothorac Surg ; 15(1): 239, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907637

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through angiotensin converting enzyme 2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia, and also causing acute cardiac injury and chronic damage to the cardiovascular system. The purpose of this review is primarily reviewing the COVID-19 disease, including pathogen, clinical features, diagnosis, and treatment with particular attention to cardiovascular involvement based on the current evidence. COVID-19 remains a threat to global public health. The associated extra-pulmonary manifestations and their prolonged consequences are frequently overlooked. Pre-existing cardiovascular disease or acute cardiac complications may contribute to adverse early clinical outcome. At the moment, there is no specific treatment for COVID-19, but multiple randomized controlled trials (RCT) are being conducted. New supportive therapies are being evaluated with promising results.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Saúde Global , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
12.
High Blood Press Cardiovasc Prev ; 27(5): 373-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32734561

RESUMO

In 2020, the Sars-Cov-2 pandemic is causing a huge and dramatic impact on healthcare systems worldwide. During this emergency, fragile patients suffering from other comorbidities, especially patients susceptible to or affected by cardiovascular disease, are the ones most exposed to the poorer outcomes. Therefore, it is still mandatory to continue to strictly adhere to the rules of cardiovascular prevention. This document aims to provide all doctors with simple and clear recommendations in order to spread useful messages to the widest number of subjects in order to continue the battle against cardiovascular diseases even in times of pandemic.


Assuntos
Betacoronavirus/patogenicidade , Cardiologia/normas , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Serviços Preventivos de Saúde/normas , Comportamento de Redução do Risco , Fármacos Cardiovasculares/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco
13.
J Am Heart Assoc ; 9(19): e016796, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32794415

RESUMO

Background The coronavirus disease 2019 (COVID-19) has developed into a global outbreak. Patients with cardiovascular disease (CVD) with COVID-19 have different clinical characteristics and prognostic outcomes. This study aimed to summarize the clinical characteristics and laboratory indicators of patients with COVID-19 with CVD, especially the critically ill patients. Methods and Results This study included 244 patients diagnosed with COVID-19 and CVD (hypertension, coronary heart disease, or heart failure). The patients were categorized into critical (n=36) and noncritical (n=208) groups according to the interim guidance of China's National Health Commission. Clinical, laboratory, and outcome data were collected from the patients' medical records and compared between the 2 groups. The average body mass index of patients was significantly higher in the critical group than in the noncritical group. Neutrophil/lymphocyte ratio, and C-reactive protein, procalcitonin, and fibrinogen, and d-dimer levels at admission were significantly increased in the critical group. The all-cause mortality rate among cases of COVID-19 combined with CVD was 19.26%; the proportion of coronary heart disease and heart failure was significantly higher in deceased patients than in recovered patients. High body mass index, previous history of coronary heart disease, lactic acid accumulation, and a decrease in the partial pressure of oxygen were associated with death. Conclusions All-cause mortality in patients with COVID-19 with CVD in hospitals is high. The high neutrophil/lymphocyte ratio may be a predictor of critical patients. Overweight/obesity combined with coronary heart disease, severe hypoxia, and lactic acid accumulation resulting from respiratory failure are related to poor outcomes. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2000029865.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Fibrinogênio/metabolismo , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X
14.
Vasc Health Risk Manag ; 16: 307-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764951

RESUMO

Purpose: This study was conducted to investigate the relationships between arterial stiffness, frailty and fall-related injuries among community-dwelling older adults. Materials and Methods: A cross-sectional study of a random sample of older adults aged 60 years and older was conducted. Main study parameters: arterial stiffness was measured by the determining the cardio-ankle vascular index (CAVI); Frailty status was defined using a 7-item frailty screening scale, developed in Russia. This questionnaire included question about falls and fall-related injuries. Orthostatic test and anthropometric tests were done. Medical history (comorbidity, medications), the Osteoporosis Self-assessment Tool (OST), nutritional, physical, cognitive and functional status were evaluated. Results: The study population included 163 people aged 60-89 years. The average predicted value of CAVI in women aged 60-69 was 9.13 ± 0.13, in men, 9.49 ± 0.05; in women aged 70-79, it was 9.49 ± 0.16, in men, 9.73 ±0.11; in women aged 80 and older it was 10.04 ±0.18, in men, 10.24 ±0.10 units. The CAVI above the predicted value was associated with fall-related injuries even after adjustment for age, sex, use of ß-blockers (BBs), history of stroke, and region of residence with the odds ratio 3.52 (95% CI: 1.03 -12.04). Conclusion: Our study revealed an independent association between arterial stiffness and fall-related injuries in older adults over 60 years. The findings suggest that clinicians, especially geriatricians, should pay attention to arterial stiffness of patients with fall-related injuries. Similarly, the patients with CAVI above age-predicted value should be evaluated for risk of falls for prevention of fall-related injuries.


Assuntos
Acidentes por Quedas , Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Rigidez Vascular , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
16.
Heart Lung Circ ; 29(9): e217-e221, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32839114

RESUMO

At the time of writing (25 May 2020), there have been nearly 4.4 million infections and 300,000 deaths worldwide related to COVID-19, an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Australia (currently 6,900 infections and 98 deaths) and New Zealand (1,500 infections and 21 deaths) have thus far been less affected than other regions. Risk factors for more severe disease include older age and pre-existing cardiovascular disease. The purposes of this document from the Paediatric and Congenital Council of the Cardiac Society of Australia and New Zealand (CSANZ) are to: 1) To review the mechanisms for cardiac involvement in COVID-19, specifically as they may impact patients with childhood and adult congenital heart disease (CHD); 2) To review the impact of SARS-CoV-2 infection in the paediatric population; 3) To review available data on the risks related to COVID-19 for childhood heart disease and adult CHD; 4) To provide guidance for childhood heart disease and adult CHD units in our Australasian region to re-organise services during the pandemic, so as to protect a highly specialised workforce and yet continue to provide an essential service; and 5) To review risk reduction strategies for acquiring COVID-19 for patients with childhood heart disease or adult CHD. Eleven (11) recommendations relevant to the care of children with heart disease and adults with CHD to mitigate the impact of COVID-19 are highlighted through the document.


Assuntos
Doenças Cardiovasculares/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Cardiopatias Congênitas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Adulto , Fatores Etários , Austrália , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Humanos , Controle de Infecções/organização & administração , Masculino , Nova Zelândia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prevalência , Medição de Risco , Fatores Sexuais , Sociedades Médicas , Análise de Sobrevida , Resultado do Tratamento
18.
J Allergy Clin Immunol ; 146(4): 808-812, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32735807
19.
PLoS One ; 15(8): e0236021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745082

RESUMO

BACKGROUND: The National Lung Screening Trial (NLST) demonstrated that annual screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. Nonetheless, the leading cause of mortality in the study was from cardiovascular diseases. PURPOSE: To determine whether the used machine learning automatic algorithms assessing coronary calcium score (CCS), level of liver steatosis and emphysema percentage in the lungs are good predictors of cardiovascular disease (CVD) mortality and incidence when applied on low dose CT scans. MATERIALS AND METHODS: Three fully automated machine learning algorithms were used to assess CCS, level of liver steatosis and emphysema percentage in the lung. The algorithms were used on low-dose computed tomography scans acquired from 12,332 participants in NLST. RESULTS: In a multivariate analysis, association between the three algorithm scores and CVD mortality have shown an OR of 1.72 (p = 0.003), 2.62 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively, and an OR of 1.12 (p = 0.044) for level of liver steatosis. Similar results were shown for the incidence of CVD, OR of 1.96 (p < 0.0001), 4.94 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively. Also, emphysema percentage demonstrated an OR of 0.89 (p < 0.0001). Similar results are shown for univariate analyses of the algorithms. CONCLUSION: The three automated machine learning algorithms could help physicians to assess the incidence and risk of CVD mortality in this specific population. Application of these algorithms to existing LDCT scans can provide valuable health care information and assist in future research.


Assuntos
Doenças Cardiovasculares/mortalidade , Aprendizado de Máquina , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Fumar Cigarros/efeitos adversos , Fumar Cigarros/epidemiologia , Ensaios Clínicos Fase III como Assunto , Vasos Coronários/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Enfisema/diagnóstico , Enfisema/epidemiologia , Enfisema/etiologia , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Feminino , Humanos , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/mortalidade , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , National Cancer Institute (U.S.) , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Estados Unidos/epidemiologia
20.
PLoS One ; 15(8): e0236836, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790674

RESUMO

BACKGROUND: Cancer is the second leading cause of death in the United States. Cancer screenings can detect precancerous cells and allow for earlier diagnosis and treatment. Our purpose was to better understand risk factors for cancer screenings and assess the effect of cancer screenings on changes of Cardiovascular health (CVH) measures before and after cancer screenings among patients. METHODS: We used The Guideline Advantage (TGA)-American Heart Association ambulatory quality clinical data registry of electronic health record data (n = 362,533 patients) to investigate associations between time-series CVH measures and receipt of breast, cervical, and colon cancer screenings. Long short-term memory (LSTM) neural networks was employed to predict receipt of cancer screenings. We also compared the distributions of CVH factors between patients who received cancer screenings and those who did not. Finally, we examined and quantified changes in CVH measures among the screened and non-screened groups. RESULTS: Model performance was evaluated by the area under the receiver operator curve (AUROC): the average AUROC of 10 curves was 0.63 for breast, 0.70 for cervical, and 0.61 for colon cancer screening. Distribution comparison found that screened patients had a higher prevalence of poor CVH categories. CVH submetrics were improved for patients after cancer screenings. CONCLUSION: Deep learning algorithm could be used to investigate the associations between time-series CVH measures and cancer screenings in an ambulatory population. Patients with more adverse CVH profiles tend to be screened for cancers, and cancer screening may also prompt favorable changes in CVH. Cancer screenings may increase patient CVH health, thus potentially decreasing burden of disease and costs for the health system (e.g., cardiovascular diseases and cancers).


Assuntos
Neoplasias da Mama/diagnóstico , Doenças Cardiovasculares/diagnóstico , Neoplasias do Colo/diagnóstico , Aprendizado Profundo , Neoplasias do Colo do Útero/diagnóstico , Adulto , Área Sob a Curva , Detecção Precoce de Câncer , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco
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