Main Comorbidities Research Articles

Sudden Cardiac Death Among Adolescents in the United Kingdom

BackgroundCauses and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood. ObjectivesThe authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents. MethodsBetween 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners. ResultsA structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic cardiomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were significantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%). ConclusionsSudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals.

Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantal bilateral vocal ford paralysis.

Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants. A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation. Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function. EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation. Level 4.

Evaluation of cognitive functions, emotional disturbances and acceptance of the disease in patients with cardiovascular disorders and type D personality

IntroductionThe majority of people with cardiovascular disorder meets the criteria of type D personality. Its prevalence, however, favours experiencing negative emotions and avoiding social connections [Kupper et al. Int J Cardiol. 2013;166(2) 327-33]. Cardiovascular disorders’ steady morbidity growth entitles to search for the factors, which have an impact on functioning, acceptance of the disorder and obeying doctor’s orders among patients with this diagnosis [Leu et al. J Formos Med Assoc. 2019;118(3) 721-729]. One of the factors, which largely determines mental efficiency, except for anxiety and depression symptoms, is cognitive functioning [Burkauskas et al. Cogn Behav Neurol.2016;29(2)91-9, Schiffer et al. Eur J Heart Fail. 2008;10(8) 802-10].ObjectivesEvaluation of cognitive functioning, acceptance of the disorder, intensifying of anxiety and depression symptoms among people who suffer from cardiovascular diseases with type D personality and seeking for relationships between those parameters.Methods102 people took part in the study, including 63 men and 39 women, the average age amounting to 65,471 (SD±10,567). Patients were divided according to the presence of type D personality, gender and cardiological diagnoses. The DS-14 scale was used to assess the type D personality, the HADS scale to assess the symptoms of anxiety and depression, and also the AIS scale to assess the acceptance of the disease and MoCA 7.2 scale for cognitive functions. The original questionnaire was used to collect the necessary sociodemographic data, data on the type and course of the main disease, comorbidities and medications taken.ResultsAbout 37% of respondents meet the criteria of type D personality. The AIS scores correlate negatively with age, disease duration, and with both components of the DS-14 scale (negative emotions-Ne and social inhibition-Hs). Both DS-14 subscales correlate positively with HADS-A and HADS-D, and the DS-14 (Ne) subscale is also positively associated with age. The results of the MoCA scale negatively correlate with age and duration of the disease. People without personality traits of type D have higher AIS scores, lower HADS-A (fig.1) and HADS-D scores (fig.2), and higher MoCA scores (fig.3) than those with type D personality. There were no differences between patients with ischemic heart disease and patients with ischemic heart disease and heart failure. In the subscale of social inhibition DS-14 (Hs), women obtained a higher result.Image:Image 2:Image 3:Conclusions1. People with D personality are more difficult to accept their illness, they are characterized by a higher level of depression and anxiety, and weaker cognitive functions.2. Women are characterized by stronger social inhibition.3. Younger people with a shorter medical history accept the disease more easily.4. Heart failure is not a factor differentiating the studied group of patients.Disclosure of InterestNone Declared

Nutritional Approaches to Modulate Cardiovascular Disease Risk in Systemic Lupus Erythematosus: A Literature Review

Systemic lupus erythematosus (SLE) is a chronic pathology characterized by a bimodal mortality pattern attributed to clinical disease activity and cardiovascular disease (CVD). A complex interaction between traditional CVD risk factors such as obesity, dyslipidemia, smoking, insulin resistance, metabolic syndrome, and hypertension, as well as the presence of non-traditional CVD risk factors such as hyperhomocysteinemia, pro-inflammatory cytokines, and C-reactive protein levels, has been suggested as a cause of the high prevalence of CVD in SLE patients. On the other hand, environmental factors, such as nutritional status, could influence the disease's prognosis; several nutrients have immunomodulators, antioxidants, and anti-cardiometabolic risk properties which could reduce SLE severity and organ damage by decreasing the development of traditional and non-traditional CVD risk factors. Therefore, this critical literature review discusses the therapeutic potential of nutritional approaches that could modulate the development of the main comorbidities related to CVD risk in SLE patients.

Legionella pneumophila Infections during a 7-Year Retrospective Analysis (2016-2022): Epidemiological, Clinical Features and Outcomes in Patients with Legionnaires' Disease.

Legionella pneumophila (LP) is one of the main causative agents of community-acquired pneumonia in Europe and its fifth bacterial cause in Italy (4.9%). We conducted a seven year retrospective analysis of LP infection serogroup 1 in Asti, Piedmont, between 2016 and 2022. Patients were included if they tested positive for the Legionella urinary antigen. Clinical, laboratory, and radiologic data were analyzed to describe the risk factors for mortality. Fifty patients with LD were collected, mainly male, with a median age of 69 years. The main comorbidities were cardiovascular diseases (50%), pulmonary diseases (26%), and neurological diseases (12%). The most common clinical presentations were fever, respiratory, gastrointestinal, and neurologic symptoms. Older age (p = 0.004), underlying cardiovascular diseases (p = 0.009), late diagnosis at admission (p = 0.035), and neurological symptoms at diagnosis (p = 0.046) were more common in the non-survivor group. Moreover, a septic-shock presentation or the need for non-invasive ventilation at admission were associated with a higher mortality. No considerable differences in the biochemical data were found between the two groups except for the median neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and PCT value. We did not find any differences in mortality related to the choice of antibiotic regimen. Differences in outcome were associated with the median duration of treatment (p =< 0.001) but not to the choice of antibiotic regimen (mainly levofloxacin or azithromycin). In conclusion, early individuation of the wide spectrum of clinical characteristics of LP infection such as respiratory, cardiac, and neurological manifestations of the patient's comorbidities, and significant biochemical data should help clinicians flag high risk patients and potentially improve their outcome.

Sex-related differences and chronobiology of ST-elevation myocardial infarction: findings from a single hub center in Italy.

Type I acute myocardial infarction (AMI) is a life-threatening condition. Time of event and rescue procedures, and sex-specific differences may play a crucial role. We aimed to investigate chronobiological patterns and sex-specific differences in a cohort of AMI patients referred to a single hub center in Italy. We considered all patients consecutively admitted for AMI (STEMI) to the Hospital of the Heart, in Massa, Tuscany (a region of Italy), between 2006 to 2018, who underwent interventional procedures. Sex, age, time of hospital admission, outcome (discharged alive/deceased), main comorbidities, and time between symptom onset and emergency medical service (EMS) activation, were analyzed. Chronobiologic analysis was applied according to hour of day, month, and season of the year. Overall 2,522 patients (mean age 64.6±13.1 years, 73% males) were considered. In-hospital death (IHM) occurred in 96 subjects (3.8%). At univariate analysis, deceased subjects were more likely to be female, older, with longer wait for EMS activation and with interventional procedures during night-time. The multivariate analysis identified female sex, age, history of ischemic heart disease, and night-time interventional procedure as independently associated factors to IHM. Chronobiologic analysis showed a pattern with a main morning peak for total sample, males, and females (p=0.00027; p=0.0006); p=0.0121, respectively). Events showed a higher peak in summer, with no differences by sex, but IHM was higher in winter. Females showed a higher delay for EMS activation, compared to males (p<0.001), but with no effects on prognosis. On the contrary, males with a delay showed higher mortality. Great effort should be spent to reduce patient-related delays in interventional procedures, being this issue crucial in both sexes.

Emergency hemodialysis in the Joseph Raseta Befelatanana hospital, Antananarivo, Madagascar

Initiation of emergency dialysis is a critical situation responsible for high morbidity and mortality. This study describes the characteristics of emergency hemodialysis patients in a hospital in Madagascar. It is a descriptive study over a period of 7 months, from September 1, 2018 to March 31, 2019, on emergency hemodialysis patients in the hemodialysis department of the University Hospital of Joseph Raseta Befelatanana, Antananarivo. Emergency hemodialysis was defined as dialysis performed immediately or within the first 48 hours of hospitalisation in a life-threatening situation. Among 124 haemodialysis patients, 52 patients (41.93%) had started dialysis as an emergency. The mean age of patients was 50.5 years and the sex ratio (male/female) was 1.08. Hypertension (51.92%) and diabetes (34.61%) were the main comorbidities. Chronic kidney disease was found in 82.7%. The majority of patients were unprepared and had initiated dialysis with a central venous catheter. The most frequent indication was Kussmaul's breathing (32.6%) followed by anuria (28.84%). The mortality rate was 23.08% and the prognosis was influenced by their condition on arrival. The predominance of chronic kidney disease and the absence of a permanent vascular approach can be explained by the late referral to nephrologists of patients with chronic kidney disease. Efforts need to be made to increase the proportion of scheduled dialysis patients with a permanent approach.

Digital Ulcers: Multidisciplinary Approach and Dermatological Management.

Digital ulcers represent a current public health issue, due to the relevant difficulties in their management and their tendency to become chronic, non-healing lesions. Our case series represents an opportunity to discuss the main comorbidities of digital ulcers and to present an evidence-based treatment protocol that has proved highly effective in our clinical practice. We collected the clinical data about clinical features, associated diseases and diagnostic therapeutical procedures of 28 patients with digital ulcers referred to our Wound Care Service at S. Orsola-Malpighi Hospital. Digital ulcers were divided into 5 categories, based on the causative agent: peripheral artery disease: 5/16 females and 4/12 males, diabetes-associated wounds: 2/16 females and 1/12 males, mixed wounds: 4/12 males, pressure wounds: 3/16 females and 2/12 males, and immune-mediated diseases associated with wounds: 6/16 females and 1/12 males. Each group received specific management, based on the characteristics of the ulcer and the underlying comorbidities. The clinical evaluation of digital wounds requires a thorough knowledge of their aetiopathogenesis. A multidisciplinary approach is necessary to achieve a precise diagnosis and correct treatment.

Study of the accuracy of a radial arterial pressure waveform cardiac output measurement device after cardiac surgery

BackgroundLess invasive monitoring, such as radial arterial pulse contour analysis (ProAQT® sensor), represents an alternative when hemodynamic monitoring is necessary to guide postoperative management and invasive monitoring is not technically feasible. The aim of the study is to evaluate the accuracy of the ProAQT® sensor cardiac output measurements in comparison with Pulmonary Artery Catheter (PAC) during the postoperative course of patients who underwent cardiac surgery with cardiopulmonary bypass.Case presentationProspective observational study in a Surgical Intensive Care Unit of a tertiary university hospital. Ten patients with a mean age of 73.5 years were included. The main comorbidities were hypertension, diabetes, dyslipidemia and the preoperative left ejection fraction was 43.8 ± 14.5%. Regarding the type of surgery, six patients underwent valve surgery, two underwent coronary artery bypass grafting and two underwent aortic surgery. The cardiac index measured simultaneously by the ProAQT® sensor was compared with the PAC. The parameters were evaluated at predefined time points during the early postoperative courses (6 h, 12 h, 24 h, 48 h and 72 h). The degree of agreement with the cardiac index between the PAC and the ProAQT® sensor along the time points was measured using the concordance correlation coefficient, Bland–Altman analysis, and four-quadrant plot. Sixty-three pairs of measurements were analyzed. We showed that measurements of cardiac index were slightly higher with PAC (β ̂ = − 0.146, p-value = 0.094). The concordance correlation coefficient for the additive model of cardiac index was 0.64 (95% Confidence Interval: 0.36, 0.82), indicating a high concordance between both sensors. Bland-Altmann analysis showed a mean bias of 0.45 L·min−1·m−2, limits of agreement from − 1.65 to 2.3 L·min−1·m−2, and percentage of error was 82.5%. Four-quadrant plot of changes in cardiac index showed a good concordance rate (75%), which increases after applying the exclusion zone (87%).ConclusionsIn patients undergoing cardiac surgery, the ProAQT® sensor may be useful to monitor cardiac index during the postoperative period, especially when more invasive monitoring is not possible.

Congenital Heart Disease in Rural Senegal: A Retrospective Study of 79 Patients

Introduction: Congenital heart disease (CHD) is a malformation of the heart present at birth and resulting from a developmental defect during embryonic life. The aim was to assess CHD in rural areas. Methodology: This is a retrospective study conducted over a period of 2 years in rural Senegal. Results: During the study period, we collected 79 patients with CHD, representing a hospital prevalence of 2.6%. The mean age at diagnosis was 17.05 months and the sex ratio was 1.19. The mean birth weight was 2826 g. The main comorbidities were anaemia (54.43%) and respiratory infections 38 cases (48.10%). Respiratory distress was the most common sign with 98.73%. Radiological cardiomegaly was noted in 86.7%. The most frequent CHD were interventricular septal defect (IVD) 21.51% and atrial septal defect (ASD) 8.86%. No patient was able to receive surgical treatment. Seven children died (8.86%) and 21 children were lost to follow-up (26.58%). On Doppler echocardiography, 16.45% of the patients had pulmonary arterial hypertension (PAH). Conclusion: In light of this work, emphasis should be placed on the quality of antenatal consultations, the quality of management and the regular availability of echocardiography and a cardio-paediatrician in order to reduce morbidity and mortality.

Evaluation of Drug-Related Problems among Chronic Kidney Disease Patients by Clinical Pharmacist

Background The prevalence of chronic kidney disease CKD in India is 17.2 with nearly 6 having Stage 3 CKD or worse. CKD patients are at greater risk for drug related problems DRPs due to high incidence of comorbidities.Aim of the study The main aim of this study was to investigate the prescription patterns and pinpoint the numerous DRPs resulting from the treatment in patients with CKD.Methods A prospective observational research was conducted including 60 patients with CKD. DRPs were found and grouped using the Pharmaceutical Care Network Europe categorization V 5.01 after the prescription pattern was examined.Results The study included a total of 60 patients with 68.3 of participants being males. The average age of the participants was 46 years. Diabetes mellitus 28.33 and hypertension 35 were found to be the two main associated comorbidities. The average number of prescriptions was 10.9 which indicates polypharmacy. Antibiotics were the most often prescribed class of medications 15.8. Medication interactions was found to be the most prevalent DRP 49.3 followed by drug choice issues 19.27 dose issues 8.96 drug usage issues 8.96 adverse reactions 1.20 and other difficulties 9.84. Lack of knowledge ranked the first among major causes of DRP 35 42.16 followed by drug use process 25 30.12.Conclusion Drug-related problems among CKD patients were high. Prompt identification and treatment of DRPs by the health care team can enhance the health and quality of life in these patients.

The Outcome of Ultrathin-Strut Biodegradable Polymer-Coated Sirolimus-Eluting Stents in Coronary Artery Disease Patients - A Feasibility Study.

Drug-eluting coronary stents with ultrathin struts and biodegradable polymers have been shown to reduce inflammation, neointimal proliferation, and thrombus formation, leading to less early and late complications in patients with coronary artery disease as compared to thinner strut and durable polymer second-generation stents. In Oman, currently, second-generation stents are used for all patients. The purpose of this feasibility study was to evaluate the clinical safety and performance of ultrathin-strut (60 μm) biodegradable polymer-coated sirolimus-eluting stents in an all-comers patient population. This was a prospective, observational, single-center, and single-arm investigator-initiated study from August 2018 to August 2019. Inclusion criteria: 18 years of age, patients with symptomatic coronary artery disease indicated for percutaneous coronary intervention, and stenting of at least one coronary lesion. All patients were followed clinically or telephonically at 12 months after the index procedure. A total of 88 patients were recruited in the study, but 10 patients were lost to follow-up and hence excluded from the analysis. The overall mean age was 63 ± 13 years and 78% were males. The main comorbid conditions were hypertension (58%), diabetes mellitus (49%), and hyperlipidemia (26%). Fifty-three percent presented with unstable angina or non-ST elevation myocardial infarction (MI), 10% with ST elevation MI, recent MI 16%, 18% with stable angina, and 1.3% in cardiogenic shock. The mean left ventricular ejection fraction of the cohort was 46 ± 14%. Angiographically, Type A lesions were seen in 25%, Type B in 32%, and Type C in 42%. Left anterior descending stenting was done in 44%, right coronary artery in 32%, left circumflex artery in 14%, left main in 5%, and graft stenting in 4%. Device success was 96%. Procedural success was seen in 97% of patients. At 1-year follow-up, 93% were asymptomatic; overall device-oriented clinical events were 6.8% including cardiac death in 2.7%, target-vessel MI in 2.7%, and target-lesion revascularization in 1.3% which all occurred in uncontrolled diabetic patients. At index admission and 1 year, ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent study showed low device-related adverse clinical events which are comparable to published data for the second-generation stents. This feasibility study shows that these stents can be used in all types of stent-indicated patients with added advantages of biodegradable polymer and ultrathin struts. In addition, measures to prevent, diagnose, and control diabetes need to be taken in Oman as this cohort of patients develop ST after stenting.

Perfil epidemiológico da prematuridade e comorbidades associadas em recém-nascidos prematuros de muito baixo peso

Objective: To describe the major epidemiological features of prematurity, risk factors, prevalence of comorbidities, death and survival rates in very low birth weight newborns. Methods: Transversal study with rectrospective data collection from medical charts of 616 premature and very low birth weight newborns admitted to Complexo Hospital de Clínicas da UFPR (CHC-UFPR) between August 2008 and August 2018. It was studied comorbidities prevalence, survival rate and factors related to mortality. For all statistical tests, it was considered a 5% level of significance. Results: The average gestational age (GA) was 28.2 ± 2.9 weeks and the average birth weight (BW) was 997.4 ± 279.9 grams. The population with GA &lt; 28 weeks (42.5%) had a greater need for neonatal resuscitation and ventilatory support and a higher prevalence of the following diseases: respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary hypertension, pulmonary hemorrhage, peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and early-onset neonatal sepsis. The main comorbidities associated with an increased risk of death were (p &lt;0.05): RDS (OR: 4,04), pulmonary hemorrhage (OR: 5,21) and PIVH (OR: 3,32). The reduction in survival rate was associated with lower values ??of GA and BW, as well as the presence of respiratory and neurological comorbidities. Conclusions: Extremely premature newborns have a higher prevalence of comorbidities and neonatal complications. Low birth weight, morbidities of the respiratory and neurological systems were the main factors associated with increased mortality.

Perfil epidemiológico da prematuridade e comorbidades associadas em recém-nascidos prematuros de muito baixo peso

OBJECTIVE: To describe the major epidemiological features of prematurity, risk factors, prevalence of comorbidities, death and survival rates in very low birth weight newborns. METHODS: Transversal study with rectrospective data collection from medical charts of 616 premature and very low birth weight newborns admitted to Complexo Hospital de Clínicas da UFPR (CHC-UFPR) between August 2008 and August 2018. It was studied comorbidities prevalence, survival rate and factors related to mortality. For all statistical tests, it was considered a 5% level of significance. RESULTS: The average gestational age (GA) was 28.2 ± 2.9 weeks and the average birth weight (BW) was 997.4 ± 279.9 grams. The population with GA &lt; 28 weeks (42.5%) had a greater need for neonatal resuscitation and ventilatory support and a higher prevalence of the following diseases: respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary hypertension, pulmonary hemorrhage, peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and early-onset neonatal sepsis. The main comorbidities associated with an increased risk of death were (p &lt;0.05): RDS (OR: 4,04), pulmonary hemorrhage (OR: 5,21) and PIVH (OR: 3,32). The reduction in survival rate was associated with lower values ??of GA and BW, as well as the presence of respiratory and neurological comorbidities. CONCLUSIONS: Extremely premature newborns have a higher prevalence of comorbidities and neonatal complications. Low birth weight, morbidities of the respiratory and neurological systems were the main factors associated with increased mortality.

A linha tênue entre a promoção da saúde e a reprodução de discursos gordofóbicos pelos médicos

Abstract: Introduction: Body weight control is essential for the treatment and prevention of the main comorbidities in the world, such as hypertension, dyslipidemia and obesity. However, medical guidelines regarding weight loss are often not evidence-based or clearly communicated, and they also do not take into account the psychological and social conditions of patients, as dictated by the values of health promotion, but rather, approached in a prejudiced and shallow way. This study seeks to answer the following question: Is the manner physicians deal with their patients’ obesity a way of promoting health or of propagating even more unfavorable clinical outcomes in this population? Objective: This study aimed to review the literature regarding medical fatphobia and its impacts on the patient. Method: This is an integrative literature review, carried out in January 2022. The data search took place from the year 2007 to January 2022. The following databases were used: SciELO, Lilacs and PubMed. The following descriptors were used in the search for articles: Obesity, Overweight, Social Stigma, Social Discrimination, Bullying, Fatphobia, Weight Bias, Medication Adherence, Therapeutic Alliance, Health Professionals, Binge-Eating Disorder. Result: The 16 selected articles were classified according to type of study, year, place, target audience and results, and then critically analyzed. Conclusion: Although it is crucial for doctors to warn their patients about weight loss, these guidelines, when made in a prejudiced, rude way and without well-defined goals, make them not interested in taking care of their own health, or even trying to lose weight without professional support. Therefore, instead of fighting obesity, its current management is responsible for aggravating it and even developing other comorbidities, such as depression.

Prevalence and Contributing Factors of Orthostatic Hypotension in the Cardiology Department of the CHU Ignace Deen in Conakry

Introduction: Orthostatic Hypotension (OH) is a frequent situation during consultation in hypertensive patients. The prevalence in the general population increases with age and it is recommended to systematically search for it in patients with multiple comorbidities. The objective of this study was to determine the prevalence of orthostatic hypotension; describe their socio- demographic profile, the various clinical and paraclinical aspects and the predisposing factors of orthostatic hypotension in treated hypertensives, controlled or not. Method: This was a descriptive cross-sectional study, from January 2 to June 30, 2022 in the cardiology department of the Ignace Deen National Hospital. Included in this study were all patients who presented with orthostatic hypotension under antihypertensive treatment, regardless of age and sex, and who agreed to participate in the study. The non-inclusion criteria were hypertensive patients without OH and those who had not agreed to participate in the study. Each patient had blood pressure and heart rate measured in the supine position at room temperature and with an empty bladder. Then the measurement is taken again three (3) minutes after the switch to orthostatism. We retained the diagnosis of OH if the SBP drops by at least 20 mmHg and/or the PAD by at least 10 mmHg three (3) min after the transition to orthostatism. Our data obtained were analyzed in the Epi-info 7.4.0 software. Results: During our study period, we investigated 385 presented with OH, 12.2%. The mean age of the patients was 60.83 years ± 10.01 years and hypertensive patients, 47 of whom the M/F sex ratio was 0.81. In our study, blood pressure was not controlled in 36.2% of our patients with a predominance of grade 3 hypertension, a rate of 55.32%. Renal failure, anemia, heart failure and stroke were the main comorbidities associated with the occurrence of HO. The most incriminated factors were age with a frequency of 74.47%, followed by obesity at 44.68% and diabetes at 27.66%. BP was normally controlled with a rate of 68.8% in treated hypertensive patients with OH. It is found much more in patients using triple therapy, a rate of 61.71%. Conclusion: The prevalence of OH is high in our department. It is found much more in patients using triple therapy. The most incriminated factors were age followed by obesity and diabetes.

Safety assessment of medicines available in the ‘Brazilian list of essential medicines’ in the older persons according to the Beers Criteria

Objective: To describe the safety of medicines available in the “Brazilian List of Essential Medicines” (RENAME/2022) for the main comorbidities that affect older persons according to the Beers criteria 2019. Methods: Medicines listed in RENAME and recommended by the respective Brazilian medical guidelines for the treatment of hypertension, heart failure, diabetes, and neurological/ psychiatric diseases were evaluated for their safety profiles according to the Beers criteria 2019. Results: Fifty-eight out of 529 medicines in RENAME were evaluated. Of these, 29 were included in any of the Beers criteria: 20 were classified as potentially inappropriate, 17 should be avoided due to disease exacerbation, and 14 needed to be used with caution. Considering drugs used to treat cardiovascular, diabetes, and neurological/psychiatric disorders, 40.00, 37.50 and 60.00% respectively, had some criterion for their appropriate use in older persons. Conclusion: RENAME presents alternatives for the safe treatment of older patients. In the treatment of cardiovascular diseases, diabetes, and neurodegenerative diseases, the firstchoice recommendations are available in RENAME. Regarding psychiatric disorders, safe pharmacological alternatives are still scarce and need to be better discussed.

Rhinosinusitis among children and adolescents in Southwestern Nigeria

Worldwide, rhinosinusitis is a common sinus and nasal condition. The purpose of this study was to determine the prevalence and clinical characteristics of rhinosinusitis among children and adolescents in Ekiti, in the southwest of Nigeria. This two-year retrospective hospital study included 161 children and adolescents who had rhinosinusitis at the Ekiti State University Teaching Hospital in Ado Ekiti, southwest Nigeria. SPSS version 18 was used to analyze the data. There were 161 participants, ages 2 to 17, mean ± SD = 6.8 ± 4.5. 101 (62.7%) of them were males, making the male to female ratio 1.5:1. 9.2% of the participants in this study had rhinosinusitis. Recurrent rhinosinusitis (41) and chronic rhinosinusitis (61) were the two most prevalent types of rhinosinusitis. According to the etiology, 81 (50.3%) cases of infective rhinosinusitis were the main clinical pattern, followed by 67 (41.6%) cases of allergic rhinosinusitis and 13 (8.1%) cases of vasomotor rhinitis. There were 127 cases of nasal stuffiness (78.9%), 108 cases of rhinorrhea (67.1%), 92 cases of snoring (57.1%), and 86 cases of coughing (53.4%). Adeno-tonsillar hypertrophy, nasal foreign body impaction, and asthma were the three main comorbid conditions with rhinosinusitis in children, with 96 (59.6%), 46 (28.6%), and 12 (7.5%) cases each. In this study, the most common complications of rhinosinusitis were tonsillitis (26.7%), otitis media (33.5%), orbital complications (36.6%), and pneumonia (8.1%). In Ado Ekiti, southwest Nigeria, rhinosinusitis was a common sino-nasal condition affecting children and adolescents. Due to the delayed presentation, chronic rhinosinusitis was the most frequent type.

Acute Limb Ischemia in COVID-19 Patients: A Single University Center Experience.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is currently known to lead to high rates of thrombotic complications. Of those, acute limb ischemia (ALI) was most frequently reported. Several case reports or case series had already described high mortality and amputation rates. The purpose of our study was to highlight the epidemiological, clinical, and management characteristics of coronavirus disease 2019 (COVID-19)-related ALI patients. Methods This was a monocentric, observational, and retrospective study. Records of all patients ≥18 years of age admitted with ALI and a confirmed diagnosis of COVID-19 infection between March 2020 and December 2021 were retrospectively examined. Data collected included demographics, co-morbidities, biological findings, COVID-19 pneumonia and ALI severity, anatomical location of arterial thromboembolism, treatments, and outcomes. Results During the study period, 22 patients with ALI infected with COVID-19 were evaluated. The median age was 67 years (45-88) and 18 (81.8%) were men. The main comorbidities were diabetes mellitus (36.4%), smoking (22.7%), and arterial hypertension (18.2%). All 22 patients were already diagnosed positive for SARS-CoV-2. The median duration between COVID-19 diagnosis and ALI symptom onset was six days (1-13 days). The computed tomography (CT) extent of pulmonary lesions was assessed according to the French Society of Chest Imaging. The ischemic syndrome was classified on Rutherford Stage IIA (30.4%) and IIB (43.5%). Regarding thrombotic locations, ALI had occurred essentially in the lower limbs (95% vs. 5%). A revascularization procedure was performed in 14 patients (63.6%) of the patients, and primary amputation was unavoidable in five patients (22.7%). Three patients (13.6%) did not undergo operative management, two because of their hemodynamic instability and one rejected surgery. We performed 23 revascularization procedures for 14 patients and three primary amputations. Thromboembolectomy (TE) was the technique of choice (92.8%). Below-the-knee (BTK) femoropopliteal bypass was performed in one patient. Selective tibial vessel thrombectomy was performed in four patients (28.6%). The mortality rate was 27.3%. Among survivors, two secondary amputations were needed with a limb salvage rate of 68.2%. Conclusion By the apparent end of the pandemic, our study further supports the increased risk of ALI in COVID-19-positive patients. Moreover, the results affirm the unfavorable outcomes highly impacted by rethrombosis, reinterventions, and consequently high rates of amputations and mortality.

Efficacy of controlvit as a complementary strategy in reducing hospitalizations in patients with heart failure. Randomized clinical trial

Abstract Introduction In patients with heart failure, the main cause of hospital admissions is due to episodes of decompensation, which are associated with an increase in the costs and resources needed for care; they have a negative impact on the quality of life and prognosis of the disease. Therefore, it is necessary to design, evaluate and implement alternatives to achieve efficient follow-up and monitoring, improving adherence to treatment and helping identify decompensation episodes that facilitate their early treatment, so new hospital admissions can be avoided. For this reason, the use of information and communication technologies (apps) is emerging as an excellent strategy for the possibility of improving coverage, real-time monitoring and timeliness of care. ControlVit® is an electronic application that allows permanent, real-time monitoring of biomedical measurements for early detection of complications. Objective To determine the efficacy of ControlVit® as a complementary strategy in reducing hospital admissions in patients in a heart failure program. Methodology A randomized, placebo-controlled, open-label clinical trial was conducted, (n=140), included patients with heart failure under controlled clinical follow-up in a structured heart failure program, into NYHA FC II–IV, capable of handling smartphones and with permanent internet connectivity. All patients were provided with educational elements, a scale and a blood pressure monitor to enter clinical data and a symptom questionnaire necessary for follow-up. The patients were randomized to 2 groups: intervention: use of ControlVit® vs. placebo, with a 6-month follow-up. The primary outcome was the difference in readmissions for heart failure between the 2 groups. Patients on the waiting list for heart transplantation or use of ventricular assist devices were excluded. All participants signed informed consent and the protocol was approved by the institutional ethics committee. Results A total of 140 patients were included in the study (intervention = 71, placebo = 69), with an average age of 66 years, 71% were men, the main etiology of heart failure was ischemic (60%), the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). During follow-up, there were 6 deaths (3 in each group) and 17 readmissions (3 in the intervention group and 14 in the control group). After adjustment for comorbidities, HR 0.72 CI95 (0.52; 0.92), p=0.0325 was found. Conclusion In patients with heart failure, ControlVit® is a useful and complementary tool for follow-up, which reduces hospital admissions due to episodes of decompensation. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): German Saldarriega award.Javeriana University