Chronic Coronary Heart Disease Research Articles

Editorial: Novel and potential biomarkers for prediction of outcome in patients with chronic and acute coronary heart disease, volume II

Editorial: Novel and potential biomarkers for prediction of outcome in patients with chronic and acute coronary heart disease, volume II

Detection of left ventricular systolic dysfunction in patients with ischemic heart disease using spatial and frontal QRS-T angles of the electrocardiogram

Aim. To evaluate the possibilities of the spatial QRS-T angle (sQRS-Ta) and the frontal QRS-T angle (fQRS-Ta) to detect low left ventricular ejection fraction (LVEF) in patients with chronic coronary heart disease. Materials and methods. We analyzed the data of 287 patients with chronic coronary artery disease, in 80 cases complicated by chronic heart failure with low LVEF. fQRS-Ta was calculated as absolute value of the difference between the frontal plane QRS and T axes. sQRS-Ta was calculated using the synthesized vectorcardiogram as a spatial angle between the integral QRS and T vectors. Results. The fQRS-Ta values in the group were 70 [25; 141]°. sQRS-Ta values in the group were 96 [55; 148]°. There were correlations between fQRS-Ta and LVEF (r=-0.58; p0.0001) and sQRS-Ta with LVEF (r=-0.63; p0.0001). According to the ROC analysis, fQRS-Ta with a threshold value of 90° made it possible to identify patients with LVEF≤40% with a sensitivity of 85% and a specificity of 75% (area under the ROC curve 0.85±0.03) and patients with LVEF≤35% with 87% sensitivity and 69% specificity (area under the ROC curve 0.84±0.04). sQRS-Ta with a threshold value of 125° made it possible to identify patients with LVEF≤40% with a sensitivity of 86% and a specificity of 82% (area under the ROC curve 0.89±0.03) and patients with LVEF≤35% with sensitivity 93% and specificity 76% (area under the ROC curve 0.89±0.02). Conclusion. In patients with chronic coronary artery disease, as the LVEF decreases, the frontal and spatial angles between the QRS and T vectors increase. These indicators with sufficiently high sensitivity and specificity make it possible to identify patients with reduced LVEF among patients with chronic coronary artery disease.

Статеві та клініко-інструментальні паралелі рівнів ліпопротеїн(а) в пацієнтів з дуже високим серцево-судинним ризиком

In recent years it has been established that elevated levels of Lp(a) are an independent genetic risk factor for the development of atherosclerotic cardiovascular diseases and aortic stenosis, however, issues of gender and age characteristics remain controversial.The aim of study was to analyze the gender characteristics of the relationship between Lp(a) levels and atherogenic changes in the lipid spectrum of the blood, clinical and instrumental characteristics, taking into account damage to the aortic valve and the results of coronary angiography in patients with stable coronary heart disease. Materials and methods. The 106 patients with chronic coronary heart disease (CAD) were examined. The average age of the subjects was 55.00±1.0 years (95% CI 51.11-58.89), among them: 78 men and 28 women.The entire cohort of patients was divided depending on the Lp(a) levels: 1group (n=58) with a Lp(a) level less than 50 mg/dl; 2 group (n=20) with Lp(a) level 50-100 mg/dl; 3 group (n=8) with Lp(a) level 101-150 mg/dl and 4 group (n=20) with Lp(a) level more than 150 mg/dl.Research methods included: 1. General clinical examination; 2. Laboratory characteristics of lipid (with determination of Lp(a)) and carbohydrate metabolism, as well as standard biochemical parameters; 3. Instrumental examination (electrocardiography, echocardiography, ultrasound peripheral vessels examination, coronary angiography); 4. Mathematical and statistical processing of the results obtained.Results and conclusions. In patients with CAD verified by clinical-instrumental and coronary angiographic criteria, it is noted that Lp(a) levels in women are on average significantly higher (P< 0.05) than in men and increase with the onset of menopause.Close correlations have not been recorded between Lp(a) in mg/dL and total cholesterol, LDL cholesterol and non-HDL cholesterol, as well as the concentrations of glucose, glycosylated hemoglobin, serum creatinine, and the concentration of thyroid-stimulating hormone (TSH).Determined that in patients with documented atherosclerotic lesions of the coronary arteries against the Lp(a) levels above 100 mg/dl, there is a greater need for coronary revascularization. A close relationship is observed between the increase in Lp(a) levels and the percentage of detection of aortic stenosis, which confirms the pathogenetic role of this lipoprotein in the formation of this acquired aortic valve disease.

Association of FoxP3<sup>+</sup> T regulatory lymphocytes with epicardial adipose tissue thickness in patients with coronary heart disease

Background. Increase ofthe epicardial adipose tissue (EAT) thickness isassociated with development of inflammation and cardiovascular complications, however, there is no data on the relationship between EAT thickening and the number of immunosuppressive regulatory T lymphocytes.The aim. To study the number of circulating T regulatory lymphocytes and nuclear translocation ofthe FoxP3 transcription factor in patients with stable coronary heart disease (CHD) depending on the epicardial adipose tissue thickness.Materials and methods. We examined 30 patients with chronic stable CHD. The EAT thickness was measured by echocardiography. Patients were divided into groups depending on the presence and absence of EAT thickening above 5 mm (groups 1 and 2, respectively). Imaging flow cytometry was used to determine the number of T regulatory lymphocytes and the level of FoxP3 nuclear translocation. The concentration of cytokines and high sensitivity C-reactive protein (hsCRP) was determined using enzyme-linked immunosorbent assay in blood serum.Results. Anthropometric indicators of obesity and the severity of atherosclerosis were comparable between groups. In group 2, there was an increase in low-density lipoprotein cholesterol concentration (p = 0.043), ratio of low-density lipoprotein cholesterol tohigh-density lipoprotein cholesterol (p = 0.017) and the concentration ofhsCRP (p = 0.044) andIL-1β (p = 0.005), adecrease in the number and relative count of Tregulatory lymphocytes (p = 0.020 andp = 0.026, respectively), aswellas thenumber of cells withFoxP3 nuclear translocation (p = 0.018) compared togroup1. According tomultiple logistic regression, the concentration ofhsCRP, IL-1β and T regulatory lymphocytes relative count in total were the predictors of EAT thickening (accuracy 80 %; sensitivity 75 %; specificity 84,6 %; AUC = 0.89).Conclusions. Thickening of epicardial adipose tissue inpatients withcoronary heart disease is associated with a decrease in the number of T regulatory lymphocytes andFoxP3 nuclear translocation inthem in presence of comparable anthropometric parameters of obesity and the severity of coronary atherosclerosis.

Trend of Cardiovascular Diseases in the Northern Regions of the Republic of Kazakhstan at the Outpatient Level

Background: We aimed to study the rate and trends of the incidence of chronic cardiovascular diseases in urban and rural areas of the northern regions of the Republic of Kazakhstan (RK) from 2015 to 2020.
 Methods: The retrospective data were analyzed using modern methods of biomedical statistics. We used the Electronic Register of Dispensary Patients (2015-2020), where we conducted a retrospective study and trend calculations. The study included patients with chronic cardiovascular diseases (CVD) (according to the International Classifier of Diseases-10, the following nosologies were identified: I25 chronic coronary heart disease and its nosological forms (I25.0-I25.9), and patients by age categories, consisting of dispensary registration in polyclinics of the northern region of the RK.
 Results: For 2015 - 2020 in the northern region (urban and rural) of RK, 12,315 patients were registered, who were on dispensary records for the chronic CVD. This amounted to 87.3% of urban residents, and 12.7% of rural residents. The share of patients with chronic CVD in the northern region of the republic by age groups had a bimodal growth pattern with the first peak at the age of 60-74 (40.4%) and the second - at the age of 45-59 (37.7%).
 Conclusion: This study notes an increase in chronic CVD, both in urban and rural areas of the northern region of the RK. This once again proves the need for the development, implementation and use of modern tools in the provision of medical services to cardiological patients at the outpatient level, taking into account the characteristics of the northern regions of our country.

Features of the Clinical Course of Chronic Coronary Heart Disease after COVID-19 Infection

Features of the Clinical Course of Chronic Coronary Heart Disease after COVID-19 Infection

Coronary atherosclerosis and periodontitis have similarities in their clinical presentation.

Periodontitis (PE) and coronary heart disease (CHD) possess multiple mechanisms for a putative association. This case-control study compared the periodontal status among CHD subjects to controls without CHD, while also investigating atheroma invasion by known periodontal pathogens. 161 subjects participated in this study were divided into three CHD groups: No CHD, chronic CHD, acute CHD. Additional analysis involved grouping subjects according to number of atheromas: no atheroma, 1-4 atheromas, 5-18 atheromas. Data were collected from medical records, periodontal examinations, and questionnaires that included demographic, behavioral, and oral health variables. Angiographic catheterizations were analyzed according to the number of atheroma lesions, lesion size, lesion location, and atheroma lesion stability. Lipoprotein profile, inflammatory markers and cells were analyzed. The microbiological branch added 30 individuals who had their atheroma lesion and subgingival plaque analyzed using polymerase chain reaction probes against the 16 s region, red complex and Aggregatibacter actinomycetemcomitans' DNA. Subjects with CHD had high levels of systemic inflammatory markers and low levels of high-density lipoproteins compared to subjects without CHD. Subjects without CHD and clear coronaries had a prevalence of mild CAL, while individuals with more atheroma lesions had advanced CAL and more active PE. Subjects with more advanced CAL were 4 times more likely to have CHD compared to subjects with less, which is comparable to smoking. Only 4 subjects had the screened pathogens detected in atheroma, although these subjects also have the screened pathogens in subgingival plaque. However, 80% of atheromas had bacteria. CHD and PE showed similarities in progression while active PE led to more atheroma lesions that also tended to be larger in size.

Treatment Strategies for Chronic Coronary Heart Disease with Left Ventricular Systolic Dysfunction or Preserved Ejection Fraction-A Systematic Review and Meta-Analysis.

We conducted a systematic search to identify all randomized trials directly comparing invasive strategies with optimal medical therapy (OMT) in patients diagnosed with chronic CHD. Data from these trials were pooled using a random-effects meta-analysis. The primary outcome assessed was the all-cause mortality, while secondary endpoints included cardiovascular (CV) death, stroke, myocardial infarction (MI), and unplanned revascularization. This study was designed to assess the benefits of both invasive strategies and OMT in patients with preserved LV function and in those with LV systolic dysfunction. The statistical analysis of the data was conducted using the Review Manager (RevMan) software, version 5.4.1 (The Cochrane Collaboration, 2020). Twelve randomized studies enrolling 13,912 patients were included in the final analysis. Among the patients with chronic CHD and preserved LV systolic function, revascularization did not demonstrate a reduction in all-cause mortality (8.52% vs. 8.45%, p = 0.45), CV death (3.41% vs. 3.62%, p = 0.08), or the incidence of MI (9.88% vs. 10.49%, p = 0.47). However, the need for unplanned myocardial revascularization was significantly lower in the group following the initial invasive approach compared to patients undergoing OMT (14.75% vs. 25.72%, p < 0.001). In contrast, the invasive strategy emerged as the preferred treatment modality for patients with ischemic LV systolic dysfunction. This approach demonstrated lower rates of all-cause mortality (40.61% vs. 46.52%, p = 0.004), CV death (28.75% vs. 35.82%, p = 0.0004), and MI (8.19% vs. 10.8%, p = 0.03). In individuals diagnosed with chronic CHD and preserved LV EF, the initial invasive approach did not demonstrate a clinical advantage over OMT. Conversely, in patients with ischemic LV systolic dysfunction, myocardial revascularization was found to reduce the risks of CV events and enhance the overall outcomes. These findings hold significant clinical relevance for optimizing treatment strategies in patients with chronic CHD, contingent upon myocardial contractility status.

COVID-19 and Myasthenia Gravis Exacerbation in an Elderly Patient: a Case Report

Treatment of COVID-19 in elderly patients with myasthenia gravis (MG), an autoimmune disease characterized by increased dynamic muscle weakness, is associated with a number of challenges, such as chronic immunosuppression, exacerbation of MG, and polymorbidity.We present the case of an elderly patient with generalized seropositive MG who contracted COVID-19. Aggravating factors are the patient’s age, the duration of myasthenia gravis, COVID-19, and comorbidity (chronic coronary heart disease, diffuse cardiosclerosis, atrial fibrillation, NYHA class I heart failure, hyper­tension). The patient had a favorable outcome despite the exacerbation. The patient required intravenous injections of immunoglobulin (1 mg/kg) for 2 days, non-invasive ventilatory support, and treatment of respira­tory and urogenital nosocomial infections (Pseudomonas aeruginosa and Klebsiella oxytoca).COVID-19 led to exacerbation of MG, progression of muscle weakness, development of respiratory failure, and hypoxia in an elderly patient. Intravenous immunoglobulin is a possible effective medication in the treatment of this comorbid pathology.During the COVID-19 pandemic patients with MG may be at greater risk of worse outcomes than healthy individuals due to an immunodeficient state associated with immunotherapy and possible respiratory and bulbar muscle weakness. The examination of patients with MG and a COVID-19 may reveal new pathogenetic patterns and change the therapeutic strategy.Knowledge of the essence of the disease, the main links of its pathogenesis, the spectrum of modern therapeutic agents, and algorithms for their use allow us to improve the quality of medical care for patients with MG. The implementation of a comprehensive multidisciplinary approach in the treatment of these patients allows us to significantly reduce the mortality rate, prolong the life of patients, and improve its quality.

Peculiarities of Metabolism and Cardiac Electrical Activity in Patients with Chronic Obstructive Pulmonary Disease and Coronary Heart Disease in the Presence of Metabolically-Associated Liver Steatosis

While the development of specific steatohepatitis-associated cardiomyopathy (SHACMP) in the context of fatty liver disease has been documented, it remains unclear whether any cardiac changes occur during the initial stage of fatty liver disease, known as metabolic-associated liver steatosis (LS). Objective — to evaluate the characteristics of metabolism and electrical activity of the heart in patients with chronic obstructive pulmonary disease and chronic forms of coronary heart disease and concomitant liver steatosis. Materials and methods. 35 patients with chronic obstructive pulmonary disease, respiratory insufficiency stages I and II, coronary heart disease, atherosclerotic cardiosclerosis, and heart failure functional classes I and II, were examined. Their diagnosis and treatment were conducted in accordance with established protocols and international recommendations. Depending on the occurrence of LS, patients, matched for age, gender and lung function parameters, were divided into two groups: those suffering from it (n = 26) or not suffering from it (n = 9). Additionally, leptin level was determined, body mass index (BMI), leptin to BMI ratio, De Ritis ratio, hepatic steatosis index, glomerular filtration rate (according to MDRD) were calculated, and automatic ECG test was run. The results were processed statistically; the significance assumed at р &lt; 0.05. Results and discussion. It was established that LS was diagnosed in patients with a higher BMI and was accompanied by clear metabolic changes — higher values of leptin, leptin-to-BMI ratio, fasting blood glucose and total cholesterol levels. The criteria of LS are not only an increase in echogenicity and size of the liver, but also higher values of ALT, De Ritis ratio and hepatic steatosis index. According to the correlation analysis, the deterioration of the liver condition was accompanied by changes in the heart — tachycardia and a decrease in the angle of the QRS complex, which can be considered as signs of the development of SHACMP, characteri­zed by a prolongation of the PQ interval (р = 0.07) and a significant deviation of the angle of the QRS complex. Inflammation and endogenous intoxication are the leading mechanisms of progression of both LS and SHACMP. Conclusions. Patients with chronic obstructive pulmonary disease and chronic forms of coronary heart disease, alongside with liver steatosis, exhibit signs of steatohepatitis-associated cardiomyopathy caused by metabolic changes, inflammation and endogenous intoxication.

Abstract 19184: Depression Mediates the Relationship Between Physical Activity and Quality of Life Among Patients With Coronary Heart Disease

Background: Depression, a known comorbidity in coronary heart disease (CHD), is associated with adverse cardiac events, mortality, symptom burden, physical limitation, and poor quality of life (QOL). Evidence has shown that depression impedes self-care behaviors including, physical activity. Similarly, regular physical activity has been shown to lessen depressive symptoms and improve cardiovascular health. However, there is limited research to determine whether depressive symptoms mediate or moderate the association between physical activity and overall QOL in the older adult population living with chronic CHD. Hypothesis: Depression mediates the positive association between physical activity and QOL. Depression is a moderator of physical activity and QOL. Objectives: 1) To determine the direct effect of depressive symptoms on physical activity and QOL; 2) to investigate the mediating effect of physical activity and depressive symptoms on QOL; and 3) to test the moderating effect of depressive symptoms on physical activity and QOL. Methods: This cross-sectional study collected 20-year follow-up survey data from 126 survivors from the Heart and Soul prospective cohort study of people living with CHD. Mediation testing was conducted using the steps described by Baron and Kenny. Results: Physical activity significantly predicted QOL ( β =.133, p =.02) and significantly predicted depressive symptoms ( β =-.1918, p =.0002); depressive symptoms significantly predicted QOL( β =-0.762, p &lt;.0001). After depression was added to the model, the relationship between physical activity and QOL was no longer significant, indicating a mediating effect. The average causal mediation effect was statistically significant (.1463, p =.0002). Depression was not a moderator of physical activity and QOL (p&gt;.05). Conclusions: This study demonstrated that depression mediated the effect of physical activity on QOL. The findings underscore the importance of addressing physical activity and depressive symptoms in interventions to improve the overall well-being and quality of life of individuals living with chronic CHD.

Abstract 19098: Physical Activity is Associated With Better Quality of Life and Perceived Health

Background: People living with coronary heart disease (CHD) experience decline in physical and social functioning, contributing to poor quality of life (QOL) and perceived health. Evidence shows that physical activity in the adult population is associated with improved QOL and better perceived health, but little is known about its benefits for community-dwelling older adults with chronic CHD. Hypothesis: Engagement in the self-care activity of physical activity is strongly related to better perceived health and QOL. Objective: Describe the association between physical activity and perceived health and QOL among older adults with long-standing CHD (&gt;20 years). Methods: In this cross-sectional study, 20-year follow-up survey data were collected from 126 survivors from the Heart and Soul prospective cohort study of people living with CHD. To identify variables associated with perceived health and QOL, we utilized nested ordinal logistic regression models (four-level model). Results: The mean age for 126 surveyed survivors was 80.9 ± 9.1 years; 71.8% (n=94) were males, less than half being physically active (47.3%, n=62) and 23.7% had heart failure. Analysis adjusted for socioeconomic status (SES), physical activity, and activities of daily living (ADL) revealed a positive association between physical activity and perceived health ( aOR =2.316, p =.023) and a strong association with QOL ( aOR =2.070, p =.046). The QOL adjusted model found heart failure diagnosis was associated with lower QOL ( aOR= .431, p &lt;.033). Conclusions: Physical activity was positively associated with perceived health and QOL among older adults with CHD, even after adjusting for SES, physical activity levels, and ADL suggesting that engagement in self-care activities such as physical activity is associated improve the overall perceived health and QOL of individuals with CHD. Furthermore, the study highlighted the impact of heart failure on QOL, even after adjusting for physical activity. These findings underscore the need for interventions and programs to promote physical activity among older adults with CHD and targeted interventions in managing heart failure.

Виявлення антитіл до вірусу SARS-COV-2 у хворих на ішемічну хворобу серця та системні ревматичні захворювання до розвитку пандемії COVID-19

Seasonal coronaviruses may serve as an informative model for determining the duration of protection against reinfection during future waves of coronavirus disease. Data from the literature suggest that ELISA kits designed to detect antibodies to SARS-CoV-2 may also be sensitive to seasonal coronaviruses. The aim of our work was to perform a retrospective study to determine the presence of IgG and IgM to coronaviruses in Ukraine before the COVID-19 pandemic. The study was conducted on the serum of 321 patients with various cardiorheumatologic profiles who were treated in a hospital during 2013-2018. The obtained data indicate the possibility of cross-immunity among coronaviruses since antibodies to this virus were present in 3.3% of patients with acute myocardial infarction, 5.9% with systemic rheumatological diseases, and 27.3% with chronic coronary heart disease.

A hybrid deep neural net learning model for predicting Coronary Heart Disease using Randomized Search Cross-Validation Optimization

Coronary Heart Disease (CHD) is a life-threatening public health problem. Many chronic CHDs and health risks can be avoided, reversed, and reduced with proper risk assessment. Medical professionals find it challenging to anticipate heart attacks and heart failures since it is a complex process requiring knowledge, experience, and medical resource facilitation. Although healthcare is generally information-savvy, not all available data are analysed to find hidden patterns and make informed and timely decisions since heart disease prediction relies heavily on clinical data processing. This study proposes a hybrid deep neural net learning model for predicting CHD using the BRFSS-2015 Dataset. The best features subset is chosen based on the co-relation score and dataset classes are balanced using the cluster-abundant data class approach. Bi-direction Long Short-Term Memory (BiLSTM) and Gated Recurrent Unit (GRU) hyper-parameter tuning is accomplished using Randomized Search Cross-Validation Optimization (RSCV). In comparison to GRU, LSTM, and BiLSTM-GRU, this suggested model obtains a classification accuracy of 98.28% which outperforms existing models.

Dynamics of mortality rates from chronic and acute coronary heart disease in the regions of the Russian Federation in 2013–2021

The level of mortality from ischemic heart disease (IHD) is infl uenced by a signifi cant number of factors. Objective. Assessment of the dynamics and variability of standardized mortality rates (SMR) from chronic IHD and acute forms of ischemic heart disease (AIHD) in the regions of the Russian Federation (RF) in 2013–2021. Material and methods. Data from Rosstat for 2013–2021 on the average annual population and number of deaths in one-year age groups in 82 regions of the RF based on the “Brief Nomenclature of Causes of Death of Rosstat” (BNCDR). SMRs were calculated based on the European standard per 100,000 population. Results. From 2013 to 2019, most regions showed an unstable trend towards a decrease in SMRs from chronic IHD, myocardial infarction (MI), and other AIHD (ICD codes — I20.0, I20.1–9), and an increase in SMRs in 2020 and 2021. The greatest decrease in SMRs was registered for other AIHD (40.2 ± 37.9 in 2013 and 20.5 ± 26.8 in 2021 per 100,000 of population). The coeffi cient of variation between regional SMRs for other AIHD was 120%, for MI — 45%, and for chronic IHD — 37%. Statistically signifi cant diff erences between 2021 and 2013 were found for SMRs from chronic IHD (225.3 ± 76.5 and 207.4 ± 76.9), other AIHD, but not for MI (38.2 ± 18.1 and 30.7 ± 14). Overall, the SMRs from all forms of IHD in 2021 exceeded the indicators of 2013 in 19 regions. The variability and dynamics of regional SMRs from diff erent forms of IHD may be due to both the possibilities and quality of preventive and therapeutic measures, as well as diff erent approaches to determining the cause of death. Conclusions. Most regions show unstable dynamics towards a decrease in SMRs from diff erent forms of IHD, and the obtained results require clarifi cation of the criteria for IHD as the underlying cause of death.

Iron deficiency in myocardial ischaemia: molecular mechanisms and therapeutic perspectives.

Systemic iron deficiency (SID), even in the absence of anaemia, worsens the prognosis and increases mortality in heart failure (HF). Recent clinical-epidemiological studies, however, have shown that a myocardial iron deficiency (MID) is frequently present in cases of severe HF, even in the absence of SID and without anaemia. In addition, experimental studies have shown a poor correlation between the state of systemic and myocardial iron. MID in animal models leads to severe mitochondrial dysfunction, alterations of mitophagy, and mitochondrial biogenesis, with profound alterations in cardiac mechanics and the occurrence of a fatal cardiomyopathy, all effects prevented by intravenous administration of iron. This shifts the focus to the myocardial state of iron, in the absence of anaemia, as an important factor in prognostic worsening and mortality in HF. There is now epidemiological evidence that SID worsens prognosis and mortality also in patients with acute and chronic coronary heart disease and experimental evidence that MID aggravates acute myocardial ischaemia as well as post-ischaemic remodelling. Intravenous administration of ferric carboxymaltose (FCM) or ferric dextrane improves post-ischaemic adverse remodelling. We here review such evidence, propose that MID worsens ischaemia/reperfusion injury, and discuss possible molecular mechanisms, such as chronic hyperactivation of HIF1-α, exacerbation of cytosolic and mitochondrial calcium overload, amplified increase of mitochondrial [NADH]/[NAD+] ratio, and depletion of energy status and NAD+ content with inhibition of sirtuin 1-3 activity. Such evidence now portrays iron metabolism as a core factor not only in HF but also in myocardial ischaemia.

Assessing the knowledge of medical undergraduates on oral anticoagulation therapy.

Oral anticoagulant drugs, such as warfarin, are widely used for preventing and treating vascular and thromboembolic disease in patients with chronic atrial fibrillation, venous thrombosis, and coronary heart disease. As oral anticoagulant therapy has such a narrow therapeutic range, complications in administering these drugs can prove to have a detrimental effect on patients such as life-threatening bleeding might occur. It is therefore necessary to have an adequate knowledge about its actions and its interactions with other dietary factors or any other medication involved. This study was therefore formulated in order to evaluate the knowledge as well as to impart proper awareness to the medical undergraduate students about oral anticoagulation therapy such as to prevent any untoward situation that may arise from the process. A cross-sectional descriptive study was used to assess the knowledge on oral anticoagulant therapy among the medical undergraduates of a tertiary care hospital. A pre-validated structured questionnaire consisting of 28 questions was adopted, and a separate questionnaire was used for each student. Timing of answering the questionnaire was set at 30 minutes. Scores were evaluated such as a correct answer was given a score of one and wrong answer awarded as zero. Adequate knowledge sore was set above 70% and inadequate knowledge at less than 40%. The response rate was found out to be 67.33% with gender distribution observed to be 71% females and 29% males. From the answers evaluated, overall average score of 67.3 ± 15.9 was obtained indicating that most of the respondents have adequate knowledge about the different mechanism, drug-drug interactions, drug-food interactions, and side effects of anticoagulant therapy, and 100% of the students are well aware about the complications and procedures involved to dissipate information about warfarin therapy. Adequate exposure of students to clinical cases will further help them to focus on the importance of anticoagulation and strengthening their knowledge regarding anticoagulant drug therapy. This will influence the process of physician-patient communication for improving anticoagulation outcome.

Reversal of Type 2 Diabetes on a Whole Food Plant-Based Diet: A Case Report

Type 2 diabetes (T2D) is a metabolic disorder characterized by hyperglycemia. T2D may lead to health complications such as retinal damage, chronic kidney disease, peripheral neuropathy, systemic hypertension, and coronary heart disease. This case report presents the complete reversal of T2D in a newly diagnosed patient after initiation of a whole food plant-based diet. He was able to reverse diabetes and maintain normal blood glucose readings without any pharmacological treatment.

The impact of sport on the physical, psychological and social wellbeing of people with chronic breathlessness: A mixed-methods systematic review

Objective Sport participation may have quality-of-life benefits for people with chronic breathlessness; however, its feasibility and impact on health are unknown. We aimed to synthesise the scientific literature concerning the impact of sport for people with chronic breathlessness. Data sources Searches of MEDLINE, CINAHL, PsycINFO, Embase, SPORTDiscus and Google Scholar were conducted (May 2023). Review methods Studies were included if they assessed the impact of sport with participants who were likely to suffer from chronic breathlessness due to an underlying condition (e.g. severe asthma, heart failure). A convergent-segregated approach to synthesis in accordance with the JBI methodology for mixed-methods reviews was utilised, including meta-analytic and meta-aggregation analyses. Results A total of 22 studies met the inclusion criteria. Studies sampled 1017 participants from 13 different countries, with sample sizes ranging from 5 to 185. Causes of breathlessness consisted of chronic respiratory diseases (9 studies) and coronary heart disease (13 studies). Design-wise, 18 reported quantitative methods, 3 qualitative, and 1 mixed-methods. Conclusions Sports were well-adhered to with only minor/unrelated adverse events reported. Improvements in exercise capacity were observed although there was no impact on health-related quality of life. Other quantitative outcomes extracted varied widely across studies, making it difficult to draw firm conclusions. Participation in sports was reliably recorded at intensity consistent with moderate-to-vigorous activity despite being self-paced. Qualitative themes emphasised the positive elements of sport participation, namely, social cohesion, the capacity to incorporate culture, and the idea that participation is enjoyable rather than a necessary chore to maintain one’s health.

Formation and evolution of surgical methods for treatment of stable coronary heart disease and acute myocardial infarction (review of literature)

Currently, two methods of coronary revascularization are used in coronary surgery – percutaneous coronary interventions and coronary bypass grafting. Technical capabilities allow using them both for the treatment of chronic coronary heart disease and in surgery for acute myocardial infarction.The development of cardiosurgical and endovascular areas has gone through two main stages. The first was to develop and improve the methodology itself and the second was to create standards and recommendations governing the treatment of coronary heart disease based on experience and accumulated results. At the present stage, individual technical aspects are subject to even greater standardization, which relate to both the selection and preparation for surgical treatment and individual stages of revascularization.