Ambulatory Conditions Research Articles

From stable teamwork to dynamic teaming in the ambulatory care diagnostic process.

Dynamic teaming is required whenever people must coordinate with one another in a fluid context, particularly when the fundamental structures of a team, such as membership, priorities, tasks, modes of communication, and location are in near-constant flux. This is certainly the case in the contemporary ambulatory care diagnostic process, where circumstances and conditions require a shifting cast of individuals to coordinate dynamically to ensure patient safety. This article offers an updated perspective on dynamic teaming commonly required during the ambulatory diagnostic process. Drawing upon team science, it clarifies the characteristics of dynamic diagnostic teams, identifies common risk points in the teaming process and the practical implications of these risks, considers the role of providers and patients in averting adverse outcomes, and provides a case example of the challenges of dynamic teaming during the diagnostic process. Based on this, futureresearch needs are offered as well as clinical practice recommendations related to team characteristics and breakdowns, team member knowledge/cognitions, teaming dynamics, and the patient as a team member.

Epidemiologic Monitoring of Enterovirus (Nepolio) Infection: Rationale for Improvement

Relevance. Non-polio enteroviruses are widespread worldwide, with millions of cases being reported each year, but limited data exist on the true burden of enterovirus (non-polio) infections (EVnI) worldwide due to a lack of standardized surveillance. Considering the absence of specific prevention of EnVI and the difficulty of predicting the epidemic situation due to the diversity of types of enteroviruses, there is an obvious need for substantiating and supplementing the existing parameters of epidemiological monitoring, identifying additional indicators of morbidity risk for the purpose of timely implementing preventive and anti-epidemic measures. Aim. Rationale of necessity of additional measures of the EVnI observation for early discovery of the activation of the epidemic process. Materials and methods. The research was held during the year 2023 and included the following three components: 1. The prospective continuous observation of the patients ranging from 0 to 18 years old who received medical help in ambulatory conditions. Possible symptoms of EVnI were studied using the ambulatory diseased person’s medical cards (f. № 0/25у). 2. The research of biological material, which belonged to the healthy people and people with signs of probable EVnI. 3. The study of epidemiological connection of dew point temperature with the manifestations of the EVnI epidemic process. Results. Probable clinical symptoms of EVnI are found among 511 observed children. Positive correlational connection with EVnI is visible among exanthems (0,43, p < 0,001) and acute nasopharyngitis (0,13, p < 0,001). The maximal incidence rate of EVnI is discovered in a period from 27th to 36th week (54,35 ‰), which coincides with maximal incidence rate of acute nasopharyngitis (434,78 ‰). The rise in incidence rate of EVnI in comparison to the last period is 4,45 times (p < 0,001), while in comparison to the rise in incidence rate of acute nasopharyngitis is 2,71 times (p < 0,0001). In planned observation of examined patients with probable symptoms, EVnI disease is found amongst 78 people, the incidence rate made 254,07 ‰ and that aligns with the results of active observation of health center appeals (267,68 ‰, p > 0,99). Clinical diagnosis of EVnI is made only in 51,28 %% of all cases. As a result of ill and healthy people’s observation, their relation is found to be 6:1 respectively. The activation of the epidemic process started in concurrence with dew point temperature +4,85 °C and continued until the dew point temperature +20,33 °C. Conclusion. The existing system of epidemiological supervision over EVnI has to be enhanced by adding the research on NPEV among the people who have acute nasopharyngitis during the stable rise in dew point temperature from +5,0 °C. Taking into account the rise in the incidence rate of EVnI, it is reasonable to expand the microbiological observation of biological material which belongs to the people who have exanthems, diarrheal syndrome and healthy people

The influence of vigorous physical exertion on cardiac demand under conditions of daily living among firefighters with elevated blood pressure

BackgroundFirefighters have a high prevalence of cardiovascular disease. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD). Exercise may be protective against SCD partially due to the immediate blood pressure (BP) reductions of 5–8 mmHg following exercise, termed postexercise hypotension (PEH) ObjectivesTo examine PEH under ambulatory conditions after a maximal cardiopulmonary exercise test (CPET) among career firefighters MethodsFirefighters (n = 19) completed a maximal CPET and non-exercise control (CONTROL) in random order on separate non-workdays and left the laboratory instrumented to an ambulatory BP (ABP) monitor. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19hr. The ambulatory rate pressure product (ARPP) was calculated as ASBPxAHRx10–3 at each hourly interval. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after CPET vs CONTROL over 19hr ResultsFirefighters were middle-aged (39.5 ± 8.9 yr), overweight (29.2 ± 4.0 kg/m2) men with elevated BP (123.1 ± 9.6/79.8 ± 10.4 mmHg), while resting HR (67.7 ± 11.3 bpm) and RPP (8.4 ± 1.7mmHg*bpm*10–3) were in normal ranges. ASBP (16.6 ± 5.7 mmHg) and ADBP (3.1 ± 4.6 mmHg) increased after the CPET vs CONTROL over 19hr (ps<0.01), as did AHR (9.4 ± 7.9 bpm, p = 0.02) and ARPP (2.5 ± 1.1mmHg*bpm*10–3, p < 0.01). ConclusionsUnexpectedly, the firefighters exhibited postexercise hypertension rather than PEH. The increases in ABP and AHR we observed indicated a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.

Blood pressure measurement and assessment of arterial structure and function: an expert group position paper.

Measuring blood pressure (BP) and investigating arterial hemodynamics are essential in understanding cardiovascular disease and assessing cardiovascular risk. Several methods are used to measure BP in the doctor's office, at home, or over 24 h under ambulatory conditions. Similarly, several noninvasive methods have been introduced for assessing arterial structure and function; these methods differ for the large arteries, the small ones, and the capillaries. Consequently, when studying arterial hemodynamics, the clinician is faced with a multitude of assessment methods whose technical details, advantages, and limitations are sometimes unclear. Moreover, the conditions and procedures for their optimal implementation, and/or the reference normality values for the parameters they yield are not always taken into sufficient consideration. Therefore, a practice guideline summarizing the main methods and their use in clinical practice is needed. This expert group position paper was developed by an international group of scientists after a two-day meeting during which each of the most used methods and techniques for blood pressure measurement and arterial function and structure evaluation were presented and discussed, focusing on their advantages, limitations, indications, normal values, and their pragmatic clinical application.

Analysis of staffing of the regional health system by dental surgeons in 2019–2021

BACKGROUND: Providing qualified personnel to medical organizations is one of the priorities of the development of the health system. Improvement of staffing of dentists is relevant, as it enables increased availability and quality of dental care. Accessibility and quality of medical care involves the availability of the required number of medical personnel and level of their qualifications, achieved through the licensing of medical activities and certification and accreditation of medical personnel. AIM: To analyze the staffing of dental surgeons in medical organizations subordinate to the Ministry of Health of the Krasnodar Territory. MATERIALS AND METHODS: This study included dental surgeons of state medical organizations of the Krasnodar Territory in 2019–2021. The present study uses statistical data of reporting forms of medical organizations of Krasnodar Krai «Information about medical organization» (N 30) for the studied period. Statistical processing of the material was performed using the Microsoft Office software package applying analytical, logical, and statistical methods of research. RESULTS: Analysis of the staffing of dental surgeons in medical organizations of the Krasnodar Territory for 2019–2021 showed an increase in established posts in general for organizations and providing medical assistance in ambulatory conditions, a decrease in established posts in the hospital and occupied posts in general by organizations, as in outpatient conditions, and in stationary. Moreover, a decrease was noted in the number of individuals employed as primary workers in general positions in the medical organizations of the province and in outpatient and inpatient medical care and in the number of individuals employed as primary employees, having the highest category and simultaneously increasing with the first and second categories. Further, the study found a decrease in the number of persons in the main occupations with professional certification, an increase in the number of persons with accreditation certificates, and a decrease in the number of physical persons and of employed dental surgeons in medical organizations of the Krasnodar Territory, owing to the reduction in both outpatient and inpatient conditions. CONCLUSION: Analysis of staffing of the regional healthcare system by dental surgeons for 2019–2021 was conducted.

Machine learning based detection of T–wave alternans in real ambulatory conditions

Background and objectiveT-wave alternans (TWA) is a fluctuation in the repolarization morphology of the ECG. It is associated with cardiac instability and sudden cardiac death risk. Diverse methods have been proposed for TWA analysis. However, TWA detection in ambulatory settings remains a challenge due to the absence of standardized evaluation metrics and detection thresholds. MethodsIn this work we use traditional TWA analysis signal processing-based methods for feature extraction, and two machine learning (ML) methods, namely, K–nearest–neighbor (KNN) and random forest (RF), for TWA detection, addressing hyper–parameter tuning and feature selection. The final goal is the detection in ambulatory recordings of short, non-sustained and sparse TWA events. ResultsWe train ML methods to detect a wide variety of alternant voltage from 20 to 100 μV, i.e., ranging from non–visible micro–alternans to TWA of higher amplitudes, to recognize a wide range in concordance to risk stratification. In classification, RF outperforms significantly the recall in comparison with the signal processing methods, at the expense of a small lost in precision. Despite ambulatory detection stands for an imbalanced category context, the trained ML systems always outperform signal processing methods. ConclusionsWe propose a comprehensive integration of multiple variables inspired by TWA signal processing methods to fed learning-based methods. ML models consistently outperform the best signal processing methods, yielding superior recall scores.

Evaluation of Office and Ambulatory Central Blood Pressure and Augmentation Index by Two Methods and Their Changes After Lifestyle or Medical Interventions in Hypertension

ObjectiveCentral systolic blood pressure (cSBP) and augmentation index (Aix) can be evaluated in office and also in ambulatory condition, during 24-h monitoring. The aim of our study was to measure cSBP and Aix in the office and in 24-h setting cSBP with two calibration methods and also Aix. Thereafter, we aimed to compare their changes after the initiation of lifestyle modifications or antihypertensive medications.MethodsOffice cSBP and Aix were measured with the tonometric PulsePen device (PP-cSBP, PP-Aix, respectively), while 24-h ambulatory cSBP and Aix (24 h-Aix) were evaluated with Mobil-O-Graph. For the calculation of 24-h cSBP both systolic/diastolic and systolic/mean BP calibration methods were considered (24 h-cSBPC1 and 24 h-cSBPC2, respectively). In new hypertensive patients (HT) the measurements were repeated 3 months after the initiation of antihypertensive medication while in white-coat hypertensive patients (WhHT) 12 months after lifestyle modifications.Results105 patients were involved including 22-22 HT and WhHT subjects, respectively. PP-cSBP (128 ± 13 mmHg,) was higher than 24 h-cSBPC1 (118 ± 9 mmHg, p < 0.05), but equal with 24 h-cSBPC2 (131 ± 11 mmHg). PP-Aix (14 ± 14%) was lower than 24 h-Aix (22 ± 7%, p < 0.05). For medical intervention PP-cSBP (Δ16 mmHg) decreased more, than 24 h-cSBPC1 (Δ10 mmHg, p < 0.05) and 24 h-cSBPC2 (Δ9 mmHg, p < 0.05).ConclusionsOffice tonometric and 24 h oscillometric cSBP values differ depending on the calibration. When examining the effect of antihypertensive treatment, the more marked changes in office tonometric cSBP suggests its higher variability compared with 24 h oscillometric central SBP. During follow-up, the two calibration methods of 24 h-cSBP seems not to be interchangeable.

Optimization of pharmaceutical care for children with diseases of the upper respiratory tract in outpatient polyclinic institutions

Introduction. The analysis of scientific and information materials has shown that the theoretical foundations and conceptual provisions of pharmaceutical management and pharmacoeconomic research have been developed in the works of domestic scientists. At the same time, research on optimization of pharmaceutical care for children in outpatient facilities is currently only fragmentary, and there is no systematic approach to solving this problem.&#x0D; The aim of the study. On the basis of a systemic approach, form a system of research on the optimization of pharmaceutical care for children with ENT diseases in outpatient polyclinic institutions.&#x0D; Materials and methods. The methodological basis is the approaches of modern management in the field of strategic management, pharmacoeconomics, approaches to the assessment of drug consumption, legislative and regulatory documents. The objects of the study were family outpatient clinics and children's outpatient polyclinic institutions in the city of Kyiv and the Kyiv region. The initial information was 390 outpatient charts of patients with ENT diseases aged 3 to 17 years for the period of 2022; 125 expert questionnaires of otolaryngologists; 50 questionnaires of a sociological survey of parents of patients with ENT diseases. The research used methods of logical, structural analysis, SWOT analysis, sociological methods (expert opinions, interactive survey, questionnaire).&#x0D; Results. A methodical approach to conducting pharmacoeconomic studies of pharmaceutical care for children in outpatient clinics has been developed. For the first time, an original method of multi-aspect matrix analysis was proposed, which makes it possible to evaluate and multi-factorially position the medicinal products of the researched assortment in order to justify its inclusion in the assortment list for the treatment of a certain nosology in ambulatory polyclinic conditions.&#x0D; Conclusions. The practical significance of the research results lies in the creation of a system of approaches to optimizing pharmaceutical care for children in outpatient settings at the territorial level.

Estimating human joint moments unifies exoskeleton control, reducing user effort.

Robotic lower-limb exoskeletons can augment human mobility, but current systems require extensive, context-specific considerations, limiting their real-world viability. Here, we present a unified exoskeleton control framework that autonomously adapts assistance on the basis of instantaneous user joint moment estimates from a temporal convolutional network (TCN). When deployed on our hip exoskeleton, the TCN achieved an average root mean square error of 0.142 newton-meters per kilogram across 35 ambulatory conditions without any user-specific calibration. Further, the unified controller significantly reduced user metabolic cost and lower-limb positive work during level-ground and incline walking compared with walking without wearing the exoskeleton. This advancement bridges the gap between in-lab exoskeleton technology and real-world human ambulation, making exoskeleton control technology viable for a broad community.

Age differences in spatial memory are mitigated during naturalistic navigation.

Spatial navigation deficits are often observed among older adults on tasks that require navigating virtual reality (VR) environments on a computer screen. We investigated whether these age differences are attenuated when tested in more naturalistic and ambulatory virtual environments. In Experiment 1, young and older adults navigated a variant of the Morris Water Maze task in each of two VR conditions: a desktop VR condition which required using a mouse and keyboard to navigate, and an ambulatory VR condition which permitted unrestricted locomotion. In Experiment 2, we examined whether age- and VR-related differences in spatial performance were affected by the inclusion of additional spatial cues. In both experiments, older adults navigated to target locations less precisely than younger individuals in the desktop condition. Age differences were significantly attenuated, however, when tested in the ambulatory VR environment. These findings underscore the importance of developing naturalistic assessments of spatial memory and navigation.

Cost-effectiveness of cardiomyopathy ambulatory care with sacubitril/valsartan vs standard therapy after COVID-19 in Kazakhstan

The aim of this study is to evaluate the cost-effectiveness of 2 different therapies of cardiomyopathy (CM) after COVID -19. The focus of the study is fixed dose combination (FDC) of sacubitril/valsartan and standard therapy in Kazakhstan. This is written from the point of view of the health insurance institution. Information for the age, gender, CM therapy, number of hospitalizations, COVID-19 infection, and past cardiovascular surgeries of 237 patients with incidents of CM which required a hospitalization after a COVID-19 infection was collected. Selected patients were divided into two groups: the cost of FDC and standard therapy and the annual cost of their therapy was calculated. The incremental cost-effectiveness ratio was calculated by dividing the cost of medication therapy by the number of hospitalizations between the two compared groups. Robustness of the results was tested with deterministic and probabilistic sensitivity analyses. The study was performed in City cardiology centre of Almaty in Kazakhstan during 2020–2022. Results show that FDC is more costly but more effective, leading to fewer hospitalizations. ICER accounts for €-2,743.08 per hospitalization saved in the group on FDC vs standard of therapy. Sacubitril/valsartan is cost-effective in ambulatory conditions in comparison with standard therapy of cardiomyopathy after COVID-19 leading to savings due to the decrease in the number of hospitalizations.

The medicinal support in ambulatory conditions and the integral estimates of public health

Within the framework of the 2030 Agenda for Sustainable Development, goals were formulated, including those targeting to improve quality of life of people all around the world. The task was formulated to ensure universal coverage of health services. In 2019, the United Nations General Assembly noted that at least half of world's population have no access to basic health services. The study developed methodology to carry out comprehensive comparative analysis of values of individual public health indicators and amount of population payments for medications to confirm possibility of applying these indicators to monitor public health, including possibility of international comparisons. The study demonstrated inverse relationship between share of citizens' funds to pay for medications, index of universal health coverage and life expectancy. The stable direct relationship between such indicators as overall mortality rate from non-communicable diseases and likelihood of dying at the age of 30-70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.

Flexible, Conductive Fabric‐Backed, Microneedle Electrodes for Electrophysiological Monitoring

AbstractMicroneedle‐based electrodes have attracted significant attention due to their potential applications in high‐quality, long‐term electrophysiological monitoring. In this study, micromoulding technology is used to develop a flexible, conductive fabric microneedle (CF–MN) electrode by bonding a conductive textile to polymeric microneedle arrays. The resulting electrode conforms to the curved surfaces of the body, and the use of a conductive textile backing reduces metallization time and costs by 50% over double‐sided dry electrodes. The electrode‐skin impedance of the CF–MN electrodes is significantly lower than that of gel electrodes over a wide frequency range, and tests on healthy volunteers, both at rest and under a range of ambulatory conditions, showed that the electrodes are capable of acquiring electrocardiography (ECG) and electromyography (EMG) signals that have a comparable kurtosis and signal‐to‐noise ratio to those recorded using conventional electrodes, but without the need for skin preparation or the use of a wet gel. The biomechanical properties of the electrode are also characterized. This is the first demonstration of CF–MN electrodes that can ultimately be integrated into clothing, which in turn can facilitate personalized cardiac health management by enabling continuous, long‐term ECG/EMG monitoring during daily activities.

Early detection of Parkinson's disease in ambulatory conditions

Early detection of Parkinson's disease in ambulatory conditions

Skeletal muscle-specific inducible AMPKα1/α2 knockout mice develop muscle weakness, glycogen depletion, and fibrosis that persists during disuse atrophy.

The 5' adenosine monophosphate-activated protein kinase (AMPK) is an important skeletal muscle regulator implicated as a possible therapeutic target to ameliorate the local undesired deconditioning of disuse atrophy. However, the muscle-specific role of AMPK in regulating muscle function, fibrosis, and transcriptional reprogramming during physical disuse is unknown. The purpose of this study was to determine how the absence of both catalytic subunits of AMPK in skeletal muscle influences muscle force production, collagen deposition, and the transcriptional landscape. We generated skeletal muscle-specific tamoxifen-inducible AMPKα1/α2 knockout (AMPKα-/-) mice that underwent 14 days of hindlimb unloading (HU) or remained ambulatory for 14 days (AMB). We found that AMPKα-/- during ambulatory conditions altered body weight and myofiber size, decreased muscle function, depleted glycogen stores and TBC1 domain family member 1 (TBC1D1) phosphorylation, increased collagen deposition, and altered transcriptional pathways. Primarily, pathways related to cellular senescence and mitochondrial biogenesis and function were influenced by the absence of AMPKα. The effects of AMPKα-/- persisted, but were not worsened, following hindlimb unloading. Together, we report that AMPKα is necessary to maintain skeletal muscle quality.NEW & NOTEWORTHY We determined that skeletal muscle-specific AMPKα knockout (KO) mice display functional, fibrotic, and transcriptional alterations before and during muscle disuse atrophy. We also observed that AMPKα KO drives muscle fibrosis and pathways related to cellular senescence that continues during the hindlimb unloading period.

Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians

BackgroundPrescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. ObjectivesTo explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. MethodsEight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. ResultsThere were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. ConclusionsThis study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.

Effect of ambulation following 18F-fluorodeoxyglucose injection on standing positron emission tomography of the healthy equine digit.

Measure 18F-FDG uptake in digital tissues of healthy horses subjected to different ambulatory conditions between the time of injection and positron emission tomography (PET) scan acquisition. 8 healthy adult horses. Horses were walked (AMB) or tied in stalls (NONAMB) immediately after injection with ∼1.5 MBq/kg 18F-FDG until scan acquisition using a randomized crossover design. Steps were quantified using accelerometers. Standardized uptake values (SUV; mean and maximum) in digital tissues including the dorsal lamellae (proximal, middle, and distal), quarter lamellae (medial and lateral), and coronary band were analyzed using a mixed-effects linear regression model. Mean (95% CI) step count for AMB (569[484-653]) was higher than NONAMB (88[24-152]) P = <.001. The SUVmax (but not SUVmean) was increased in AMB compared with NONAMB in the proximal (2.74[2.52-2.98] vs 2.42[2.05-2.78]; P = .04) and middle (2.74[2.37-3.11] vs 2.36[2.05-2.68]; P = .03) dorsal lamellae but was not different in the distal lamellae or coronary band. In the medial quarter lamellae, both SUVmax (2.53[1.58-3.48] vs 2.07[0.81-3.33]; P = .01) and SUVmean (1.90[1.55-2.25] vs 1.49[0.91-2.06]; P = .007) were increased in AMB compared with NONAMB. The medial quarter lamellae also had lower SUVmax (P = .002) and SUVmean (P = .04) compared with the lateral quarter and lower SUVmax compared with the mid-dorsal lamellae (P = .01). Lamellar 18F-FDG uptake was affected by ambulatory activity mostly in the medial quarter; however, this effect was relatively small and unlikely to interfere with clinical detection of laminitis.

ОЦЕНКА ПСИХИЧЕСКОГО ЗДОРОВЬЯ РЕКОНВАЛЕСЦЕНТОВ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ

From the start of the new coronavirus pandemic there remains the question about its effects on the psyche of people. Judging from the earlier cases of similar illnesses like MERS or TOPC, some researchers assume that the new coronavirus infection can lead to a harsher or worser course of many mental illnesses. With the goal of finding those patterns we conducted a survey of people who were infected with the new strain of the coronavirus infection of different levels in the Republic of Sakha (Yakutia). The survey covered 82 respondents of different age groups (from 18 to 30 years old – 43 people, from 31 to 44 years old – 13 people, from 45 to 59 – 21 people, from 60 to 74 – 5 people), with 69 individuals being female (84.2 %) and 13 individuals being male (15.8 %). The average age of the respondents was 34.5 years. Out of all the respondents, 23 (28 %) people received the treatment in hospital, 59 (72 %) people were treated in ambulatory conditions. The survey was based on the hospital anxiety and depression scale (HADS). This scale consists out of two parts and 14 questions, with each part including 7 questions. For the study, the hospital anxiety and depression scale (HADS) was duplicated, which means it had variations to assess how the respondents feel before and after being infected with the new strain of the coronavirus. The results of the survey of those people that had the new coronavirus infection and were graded by the HADS, the signs of clinical depression were seen in 2.4 % of the respondents before being infected with the new strain of coronavirus; after being cured this group of respondents increased to 14.7 %. Before the illness, signs of clinical depression were manifested in 1.2 % of the respondents; after the illness this number grew to 6.1 %. The signs of needed clinical anxiety were shown by 6 respondents (7.3 %); clinical depression was diagnosed in 14 respondents (17.1 %). An increase state of anxiety was found in the elderly (3.6 %) and states of depression in the young (17 %).

#5699 IS GFR DECLINE INDUCED BY SGLT-2 INHIBITOR OF CLINICAL IMPORTANCE?

Abstract Background and Aims Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with better cardiovascular outcome and with nephroprotection independent of diabetes status. However, the use of SGLT2i often cause an initial decline in estimated glomerular filtration rate (eGFR). This study addresses the question whether there is a relationship between vascular improvement and GFR dipping. Method We measured GFR (mGFR) and calculated GFR (eGFR) in 65 patients with T2D at baseline and after 12 weeks of treatment with either a combination of Empagliflozin (E) + Linagliptin (L) (n = 34) or Metformin (M) + Insulin (I) (n = 31). mGFR was measured using the gold standard clearance technique by infusion of inulin. In addition, pulse wave velocity (PWV) was obtained at office and under ambulatory conditions. We splitted the study cohort according to the median change of mGFR after 12 weeks and compared the baseline characteristics. Results mGFR and eGFR decreased significantly with E+L and with M+I (Ott C et. al. Cardiovasc Diabetol. 2021). However, no correlation was noticed between the change of mGFR and change of eGFR for either treatment cohorts (E+L: p = 0.404; M+I: p = 0.460). We found a significant decrease in office PWV in the E+L group only (8.2±1.6 to 7.8±1.5, p = 0.028) without any change in 24-h PWV. The change of office PWV correlated with the change of mGFR (p = 0.009) in E+L group only and remained significant after adjustment for the change of office systolic BP (p = 0.018). In addition, we observed a correlation between the change of high sensitive C reactive protein (hsCRP) and change in mGFR (p = 0.031). We identified patients with higher albumin excretion (p = 0.044), higher fasting plasma glucose (p = 0.014) and high hsCRP (p = 0.057) to have a greater decline in mGFR with E+L. Conclusion First, eGFR may not be an appropriate parameter to assess the true change in renal function after receiving E+L in a single patient. Second, after E+L medication a high decrease in mGFR goes in parallel with vascular improvement and less inflammation thereby reflecting the pleiotropic pharmacologic effects of SGLT 2 inhibitors.

QT interval time lag in response to heart rate changes during stress test for Coronary Artery Disease diagnosis

Background: Slow adaptation of the QT interval to abrupt changes in heart rate (HR) can enhance ventricular heterogeneity and has been suggested as a marker of arrhythmic risk. Most investigations on QT rate adaptation lag have been performed in response to step-like HR changes. However, abrupt HR changes are difficult to induce or observe in ECG recordings under ambulatory conditions. Objective:We aim to evaluate the power of indices related to the QT lag in response to ramp-like HR changes in stress test to assess CAD risk. Methods:We quantified the lag between the actual QT series and the memoryless expected QT series, which was obtained by fitting a hyperbolic regression model to the instantaneous QT and HR measurements in stages where their behavior could be assumed stationary. The proposed methodology was applied to analyze ECG stress tests of a subset of 448 patients presenting different risk levels for Coronary Artery Disease (CAD). The QT lag was estimated separately in the exercise and recovery phases. Results:An increase in the estimated QT lag during exercise (from 25 to 36 s) and a decrease during recovery (from 57 to 39 s) were associated with higher CAD risk. The difference between these lags showed significant capacity for CAD risk stratification. Conclusion:The QT lag in response to HR changes can be quantified from a stress test. QT lag values in response to ramp-like HR changes are in ranges comparable to those quantified from abrupt HR changes and show clinical significance to stratify CAD risk.