Patients In Outpatient Clinic Research Articles

Burden of Chronic Kidney Disease in Hypertensive Patients in Medical Outpatient Clinic of a Rural Tertiary Hospital

There is an alarming rise of chronic kidney disease (CKD) prevalence globally, which is associated with significant morbidity and mortality necessitating special attention as a major public health problem. Data on the burden of CKD on the African continent are sparse for rural population. Hypertension related kidney disease accounts for a large percentage of the population requiring renal replacement therapy worldwide. Therefore, we determined the burden of CKD in patients with hypertension attending a tertiary hospital located in a rural community.

Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins

ObjectiveMechanochemical ablation (MOCA) is a nonthermal nontumescent method of treating saphenous vein insufficiency. The feasibility and short-term results of MOCA are good, but its long-term results are unknown. A randomized study was performed to compare MOCA with endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the setting of unilateral great saphenous vein (GSV) insufficiency. MethodsVenous outpatient clinic patients with varicose veins (CEAP class C2-C4) caused by GSV insufficiency were invited to participate in the study; in total, 132 patients met the inclusion criteria and were willing to participate. Patients were randomized to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the GSV with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at 1 month, 1 year, and 3 years after the treatment. ResultsSome patients declined to continue in the study after randomization; in total, 117 patients underwent treatment. At 3 years, the occlusion rate was significantly lower with MOCA than with either EVLA or RFA (82% vs 100%; P = .005). Quality of life was similar between the groups. In the MOCA group, GSVs that were larger than 7 mm in diameter preoperatively were more likely to recanalize during the follow-up period. The partial recanalizations of proximal GSV observed at 1 year progressed during the follow-up. ConclusionsMOCA is a feasible treatment option in an outpatient setting, but its technical success rates are inferior compared with endovenous thermal ablation. Its use in large-caliber veins should be considered carefully.

Evidence-based assessment in clinical settings: Reducing assessment burden for a structured measure of child and adolescent anxiety.

Clinically useful and evidence-based mental health assessment requires the identification of strategies that maximize diagnostic accuracy, inform treatment planning, and make efficient use of clinician and patient time and resources. This study uses classification tree analyses to determine whether parent- and child-report instruments, alone or in combination, can accurately predict diagnoses as measured by the Anxiety Disorders Interview Schedule (ADIS). The ADIS, which is the gold-standard semistructured interview for anxiety disorders in children and adolescents, requires formal training and lengthy administration. Data were collected as part of the standard diagnostic assessment process for 201 patients (ages 5 to 17 years) in an urban outpatient psychiatry specialty clinic. Analyses examined 2 models to determine which predictors reached an acceptable level of diagnostic accuracy for generalized anxiety, social anxiety, and separation anxiety disorders. The first model used scores on a parent- and child-report anxiety measure combined with demographic factors, and the second model incorporated a broad-band measure of child psychopathology and a depression measure into the analysis. Although demographic factors did not emerge as accurate predictors in either model, particular measures, either alone or in combination, were able to predict specific ADIS diagnoses in some cases, allowing for the potential streamlining of ADIS administration. These results suggest that a classification-tree analysis lends itself to the construction of simple algorithms that have high clinical utility and may advance the feasibility and utility of evidence-based assessment strategies in real-world practice settings by balancing cost effectiveness, administration demands, and accuracy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Urogynecology

Urogynecology

How patients in Denmark acquire their medicines: overview, data sources and implications for pharmacoepidemiology.

The means by which patients acquire their medications differ between countries, and a knowledge of this is essential when conducting and interpreting pharmacoepidemiological studies. The aim of this paper is to provide an overview of how patients obtain medicines in Denmark, to relate these to nationwide registries available for research and to discuss the implications for research. Health services are predominantly tax-funded in Denmark, with dentistry and some medicine bought at community pharmacies being exceptions, involving partial reimbursement of charges. The paper gives an overview of prescription medicines acquired from community pharmacies (including magistral preparations), over-the-counter medicines, vaccinations and in-hospital medicine including so-called "free medicine" (in Danish: "vederlagsfri medicin"). "Free medicine" is medicines for a defined list of diseases and indications that is provided free of charge to patients in outpatient clinics. The paper also describes the content of the various Danish data sources about medicine use, summarizes their strengths and limitations, and exemplifies the ways of evaluating their completeness. An example is provided of the regional variation in the means by which medicines are acquired.

Patient Acceptability of the Use of Advanced Practice Providers in an Outpatient Neurosurgery Clinic.

IntroductionIncreasing demands for healthcare manpower has necessitated the utilization of advanced practice providers (APPs). The effect of APPs in primary care has been well-characterized but is less studied in surgical subspecialties. The objective of this study is to assess the patient acceptability of APPs in an outpatient neurosurgery setting.MethodsWe conducted a prospective, survey-based study among 78 adult patients in the neurosurgical outpatient clinic. The survey consisted of 10 questions assessing the hypothetical acceptability of care provided by neurosurgeons and APPs. These were compared as pre-specified dyads, with patients blinded to dyad composition. The data were analyzed with Chi-square tests.ResultsPatients preferred to see their neurosurgeon for their first clinic visit even with a longer lag time (29% acceptability difference, p = 0.012). Patients also preferred to see the neurosurgeon for their first postoperative visit (20% difference, p = 0.009). For all visits, patients preferred to see an APP if the clinic visit would be on time, rather than see the surgeon with a significant delay (30% difference, p = 0.0002). If their visit was scheduled with an APP, patients preferred that the neurosurgeon review their treatment plan before they left the clinic (15% difference, p = 0.04). Overall, seeing an APP was acceptable if patients were informed ahead of time (37% difference, p < 0.0001).ConclusionsTeam-based care utilizing APPs is acceptable to patients. Patients had strong preferences for seeing their surgeon for the first neurosurgical clinic visit and first post-operative visit. Patients were satisfied with seeing an APP if they could be seen more expeditiously. Patients also preferred to know ahead of time if they were going to see an APP.

Exposure to dipeptidyl‐peptidase‐4 inhibitors and COVID‐19 among people with type 2 diabetes: A case‐control study

Because other coronaviruses enter the cells by binding to dipeptidyl‐peptidase‐4 (DPP‐4), it has been speculated that DPP‐4 inhibitors (DPP‐4is) may exert an activity against severe acute respiratory syndrome coronavirus 2. In the absence of clinical trial results, we analysed epidemiological data to support or discard such a hypothesis. We retrieved information on exposure to DPP‐4is among patients with type 2 diabetes (T2D) hospitalized for COVID‐19 at an outbreak hospital in Italy. As a reference, we retrieved information on exposure to DPP‐4is among matched patients with T2D in the same region. Of 403 hospitalized COVID‐19 patients, 85 had T2D. The rate of exposure to DPP‐4is was similar between T2D patients with COVID‐19 (10.6%) and 14 857 matched patients in the region (8.8%), or 793 matched patients in the local outpatient clinic (15.4%), 8284 matched patients hospitalized for other reasons (8.5%), and when comparing 71 patients hospitalized for COVID‐19 pneumonia (11.3%) with 351 matched patients with pneumonia of another aetiology (10.3%). T2D patients with COVID‐19 who were on DPP‐4is had a similar disease outcome as those who were not. In summary, we found no evidence that DPP‐4is might affect hospitalization for COVID‐19.

3-1INTRACRANIAL ARTERY STENOSIS PATTERN IN ISCHEMIC STROKE PATIENTS THROUGH TRANSCRANIAL DOPPLER(TCD) IN DR. M. DJAMIL HOSPITAL, PADANG

Background: Intracranial artery stenosis is one of significant risk factors in the occurrence of vascular disorders. Intracranial artery stenosis occurs in 33% −50% in stroke patients and 50% in transient ischemic attack patients. Transcranial doppler sonography (TCD) is one of the modalities that can detect intracranial stenosis with 79% sensitivity and 94% specificity. Transcranial doppler sonography can detect stenosis or occlusion of middle cerebral artery (MCA), bifurcatio of Internal Carotid Artery (ICA), anterior cerebral artery (ACA), vertebral arteries (VA), basilar artery (BA), and Posterior Cerebral artery (PCA). According to RSUP DR. M. Djamil medical record data that was obtained in 2018, 35.2% patients experienced intracranial arterial blood vessel disorders based on the results of TCD examination. This study aims to determine the characteristics of intracranial artery stenosis patterns in ischemic stroke patients through TCD examination in RSUP. Dr. M. Djamil Padang. Method: This study was an adescriptive study. The population was ischemic stroke patients in the Neurology Outpatient Clinic of DR. M. Djamil Hospital, Padang, who underwent TCD examination from January 1st to December 30th, 2019, with an evaluation of mean flow velocity (MFV). Results: In this study, there were 192 subjects; 57.29% of subjects were male. The most dominant age range was 51–60 years (30.21%). There were 55.73% of subjects with normal TCD results, 35.42% with intracranial artery stenosis, and 8.85% with general atherosclerosis. Based on the location, intracranial arteries stenosis was found most often in the Left Middle Cerebral Artery (26.47%), followed by Right Middle Cerebral Artery and Right Vertebral Artery (8.82%). Conclusion: Middle Cerebral Artery (MCA) is the most common location of intracranial arteries stenosis that was found in ischemic stroke patients and predominantly occurred in the left cerebral hemisphere.

Comparison of Syphilis Rapid Diagnostic Test to Rapid Plasma Reagin, Treponema pallidum Haemagglutination Assay and Fluorescent Treponemal Antibody-Absorption for Syphilis and Yaws Diagnostics

BACKGROUND: Syphilis and yaws are the treponemal infections which have become serious public health problems, and both are serologically indistinguishable. Developed serological tests for syphilis may also be used to diagnose yaws. In remote area, test modality with minimal requirements were needed. This study investigated the diagnostic value of syphilis rapid diagnostic test (RDT) in diagnosing syphilis and yaws.METHODS: For syphilis diagnostic test, serum samples were obtained from patients of outpatient clinic in Dr. Cipto Mangunkusumo National Central General Hospital who were sent for rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) to clinical laboratory of the hospital. The serum samples were collected and stored at -80°C until the day of testing for syphilis RDT and fluorescent treponemal antibody-absorption (FTA-Abs). For yaws diagnostic test, serum samples were obtained as a part of surveillance study of yaws among children 1-15 years old in West Halmahera. Venous blood samples were used for syphilis RDT and the sera were separated and were sent to Dr. Cipto Mangunkusumo National Central General Hospital for RPR, TPHA, and FTA-Abs tests.RESULTS: For syphilis diagnostic test, among 156 samples, 39 samples were positive with syphilis RDT. The sensitivity of syphilis RDT was similar to RPR and TPHA (100.0%), the specificity was same as TPHA (77.5%), but lower than RPR (84.8%) when compared to FTA-Abs IgM. The sensitivity of syphilis RDT was 62.5% and the specificity was 96.0% when compare to FTA-Abs IgG. For yaws diagnostic test, among 176 samples, 13 samples were positive with syphilis RDT. By using FTA-Abs IgM as gold standard for diagnosing yaws, the RDT have similar sensitivity (50.0%) with RPR and TPHA and syphilis RDT have similar specificity to TPHA (93.1%). If compared to FTA-Abs IgG, the sensitivity of syphilis RDT was 40.0% and the specificity was 98.0%.CONCLUSION: Syphilis RDT gives similar results with TPHA in syphilis and yaws cases. It may be used as a first line screening test latent or untreated syphilis and yaws because of good sensitivity. For yaws diagnosis Syphilis RDT, RPR, and TPHA have low sensitivity, however all those tests have an excellent agreement.KEYWORDS: FTA-Abs, rapid diagnostic test, syphilis, yaws

Dermatologic Lesions in Geriatric Patient with Diabetes Mellitus

Introduction: In geriatrics, there are changes in structure and function results in histopathological, physiological and clinical skin changes. The conditions can cause morbidity and decreases the quality of life of patients. This study was the first study that provide the characteristics of geriatric skin disorders in Dr. Mohammad Hoesin Hospital Palembang.&#x0D; Methods: This study was descriptive observational with cross-sectional design using total sampling method performed among patients in Geriatric Outpatient Clinic, Dermatology and Venereology Outpatient Clinic and geriatric inpatient room in Dr. Mohammad Hoesin Hospital on July-September 2019.&#x0D; Results: Physiological skin changes in geriatrics include xerosis cutis (13,95%), seborrheic keratosis (13,17%), guttate hypomelanosis (8,5%), senile lentigen (6,97%), freckle (2,32%), periorbital hyperpigmentation (1,55%), senile purpura (0,77%) and poikiloderma civatte (0,77%). The most skin disorder found were lichen simplex chronicus (11,1%), pressure ulcers (9,25%), senile pruritus (8,32%), asteatotic dermatitis (6.47%) and candidiasis (3,7%). The most common comorbid condition were diabetes mellitus in 16 patients (22,5%), CVD in 7 patients (9,9%), hypertension in 6 patients (8,5%), AKI in 6 patients (8,5 %), and HHD in 4 patients (5,6%). Diabetes mellitus was significantly associated with xerosis cutis (p = 0,0007), senile pruritus (p = 0,015), and guttate hypomelanosis (p = 0,016).&#x0D; Conclusion: The most physiological skin changes found in geriatric patients in Dr. Mohammad Hoesin Hospital were xerosis cutis, seborrheic keratosis, and guttate hypomelanosis, while skin disorder were lichen simplex chronicus, pressure ulcer, and senile pruritus. Diabetes mellitus was significantly associated with skin disorders.

Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights.

During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic.

Telemedicine successfully engages marginalized rural hepatitis C patients in curative care.

Rurally located individuals living with hepatitis C virus (HCV) face barriers to engagement and retention in care. Telemedicine technologies coupled with highly curative direct acting antiviral (DAA) treatments may increase accessibility to HCV care while achieving high sustained virologic response (SVR) rates. We compared clinical and socio-economic characteristics, SVR, and loss to follow-up among telemedicine (TM), mixed delivery (MD), and outpatient clinic (OPC) patients receiving care through The Ottawa Hospital Viral Hepatitis Program (TOHVHP). TOHVHP clinical database was used to evaluate patients engaging HCV care between January 1, 2012, and December 31, 2016. SVR rates by HCV care delivery method (TM versus OPC versus MD) were calculated. Analysis included 1,454 patients who engaged with TOHVHP at least once. Patients were aged almost 50 years on average and were predominately male and Caucasian. A greater proportion of TM patients were rurally based, were Indigenous, had a history of substance use, and had previously been incarcerated. Per-protocol DAA SVR rates for TM, OPC, and MD patients were 100% (26/26), 93% (440/472), and 94% (44/47), respectively. Loss-to-follow-up rates for HCV-treated TM and MD patients were higher (27% [10/37], 95% CI 0.58 to 0.88, and 11% [7/62], 95% CI 0.81 to 0.97, respectively) than for those followed exclusively in the OPC (5% [39/800], 95% CI 0.94 to 0.97). TM can successfully engage, retain, and cure rurally based HCV patients facing barriers to care. Strategies to improve TM retention of patients initiating HCV antiviral treatment are key to optimizing the impact of this model of care.

Level of personality functioning and attachment style as predictors of the successful referral to outpatient psychotherapy

Level of personality functioning and attachment style as predictors of the successful referral to outpatient psychotherapy Objectives: Outpatient psychotherapy is a key element in the effective treatment of mental health problems. First results suggest that interpersonal problems lead to difficulties in receiving outpatient psychotherapeutic treatment. The relationship between these difficulties, attachment style, and the level of personality functioning is still unclear. Methods: We invited 1011 patients of a psychosomatic-psychotherapeutic university outpatient clinic to participate in the study. The clinical diagnoses according to ICD-10, as well as symptoms of depression (PHQ-D), and quality of life (SF-36) were recorded. Hypothesized predictors for the successful referral to outpatient therapy were patient age, availability of local outpatient treatment, number of ICD-10 diagnoses, the motivation for psychotherapy (FPTM), fear of stigmatization (Stig-9), level of personality functioning (OPD-SQ), and attachment style (ECR-RD). Results: We were able to catamnestically reassess n = 300 patients (67.3 % of patients initially referred to outpatient therapy). A smaller number of clinical diagnoses, greater availability of psychotherapeutic care and higher therapy motivation, as well as a lower level of personality functioning predicted the successful referral to outpatient psychotherapy, while the combination of impaired personality functioning and avoidant attachment style was a negative predictor. Conclusions: Contrary to expectations, patients with a lower level of personality functioning are more successful in receiving outpatient psychotherapy. However, patients with a combination of impaired personality functioning and a high degree of attachment avoidance run the risk of not asserting their need for treatment.

Correlation between Allergic Rhinitis and Rhinosinusitis in ENT Outpatient Clinic Patients

Introduction: Rhinosinusitis and allergic rhinitis are common health problems. Allergic rhinitis patients tend to have edema on their nasal mucosa, disrupted cilia, and excessive secrete production that clogged paranasal sinuses’ ostiums and lead to inflammation and infection of the paranasal sinuses. There is still a contradiction of allergic rhinitis as predisposing factor of rhinosinusitis. Those correlation is not yet clear, thus we aim to analyze the correlation between allergic rhinitis and rhinosinusitis.Methods: This study was a cross-sectional design. The samples were obtained by consecutive sampling. Adult patients above 19 years old with nasal discharge were examined by the doctors on duty and interviewed. Medical data obtained was recorded and analyzed using chi square test.Results: From 98 patients, 17 patients (17.35%) had both rhinosinusitis and allergic rhinitis, 48 patients (48.98%) only had rhinosinusitis, and 13 patients (13.26%) only had allergic rhinitis. Patients who had neither rhinosinusitis nor allergic rhinitis reported to be 20 patients (20.41%). Chi square test showed that allergic rhinitis had no significant correlation with rhinosinusitis (p=0.266).Conclusion: There is no significant correlation between allergic rhinitis and rhinosinusitis. Rhinosinusitis is a multifactorial disease.

Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong

BackgroundLittle research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM).MethodsThe participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data.ResultsWe found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety–driven treatment seeking as measured by annual clinic visits.ConclusionThese findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).

Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study

Key summary pointsAimTo examine the effect of predictive factors on institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic during a 3-year follow-up.FindingsThe rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The use of home care, dementia, higher age and falls during the previous 12 months significantly predicted institutionalization during the follow-up.MessageCognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.

INNOVATIVE ASPECTS OF THE MEDICAL AND PSYCHOLOGICAL LONG-TERM REHABILITATION OF OLDAGED PATIENTS IN OUT-PATIENT CLINICS ON THE BASIC OF SPECIALIZED MEDICAL CENTRES

The innovative aspects of medical and psychological rehabilitation of the old-aged patients in out-patient clinics on the basis of specialized medical centre have been studied. As an innovation: the long-term rehabilitation work (an additional period to the main course of 14 days) on the recovery of this category of patients, taking their age peculiarities into consideration (low level of intellectual and neuro-dynamic abilities); restorative treatment in a 24-hour hospital on the basis of the multifactorial program have been offered. In both cases, the emphasis is made on the recovery in terms of the developed program “The territory of welfare”. It is a medical and psychological support of the elderly on the basis of the Rehabilitation Medical Center “RZD-Medicine”, Yekaterinburg. On the one hand, this program will give an opportunity to overcome the lack of the provision of medical and psychological services during outpatient treatment.On the other hand, the program will help to understand the necessity of the rehabilitation measures extension for the elderly patients on the basis of medical centers. This program as an approbation for including into a pilot project “The organization of a modern model of a long-term medical treatment for the elderly people based on the principles of interdisciplinary and inter-departmental interaction (The Territory of care)”and for reconsidering the practice of rehabilitation services for the elderly; it is a necessary measure for the prevention, training and activation of the internal resources of older people for their productive aging.

Clinical outcome of ultrasound-guided atelocollagen injection for patients with partial rotator cuff tear in an outpatient clinic: a preliminary study.

BackgroundAtelocollagen has been studied for restoration of rotator cuff tendon. In this study, we attempted to evaluate the clinical outcome of ultrasound-guided atelocollagen injection in an outpatient clinic for patients with partial rotator cuff tear.MethodsWe recruited 42 outpatients who visited our hospital from May 2019 to September 2019. Atelocollagen injection was performed in patients with partial rotator cuff tear diagnosed by magnetic resonance imaging and ultrasound. American Shoulder and Elbow Surgeons (ASES), Constant, Korean Shoulder Score (KSS) and Simple Shoulder Test (SST) scores, and range of motion were assessed before injection and after 2 months. Statistically, we analyzed the clinical results using the Wilcoxon signed-rank test.ResultsFinally, 15 patients were enrolled for analysis. There was no significant difference between pre- and post-injection in terms of range of motion, ASES (57.0 vs. 60.4), Constant (56.4 vs. 58.9), KSS (64.6 vs. 68.5), and pain-visual analog scale (4.2 vs. 3.7), except function-visual analog scale (F-VAS; 6.3 vs. 7.1) and SST (6.6 vs. 6.9). A significant difference was found in SST (P=0.046) and F-VAS (P=0.009). According to the ultrasound results at 2 months, we found hyperechoic materials in three of seven patients. The most common complication of atelocollagen injection was post-injection pain (53%, 8/15).ConclusionsUltrasound-guided atelocollagen injection for partial rotator cuff tear showed no significant change in terms of clinical outcomes, except for F-vas and SST score. Tendon regeneration was not clear due to the remnants of atelocollagen present at 2-month follow-up ultrasound. There seems to be alarming post-injection pain for 2 to 3 days in the patients who received atelocollagen injection in an outpatient clinic.

Elevated Plasma Levels of Circulating Extracellular miR-320a-3p in Patients with Paroxysmal Atrial Fibrillation.

The potential of extracellular circulating microRNAs (miRNAs) as non-invasive biomarkers of atrial fibrillation (AF) has been confirmed by a number of recent studies. However, the current data for some miRNAs are controversial and inconsistent, probably due to pre-analytical and methodological differences. In this work, we attempted to fulfill the basic pre-analytical requirements provided for circulating miRNA studies for application to paroxysmal atrial fibrillation (PAF) research. We used quantitative PCR (qPCR) to determine the relative plasma levels of circulating miRNAs expressed in the heart or associated with atrial remodeling or fibrillation with reported altered plasma/serum levels in AF: miR-146a-5p, miR-150-5p, miR-19a-3p, miR-21-5p, miR-29b-3p, miR-320a-3p, miR-328-3p, miR-375-3p, and miR-409-3p. First, in a cohort of 90 adult outpatient clinic patients, we found that the plasma level of miR-320a-3p was elevated in PAF patients compared to healthy controls and hypertensive patients without AF. We further analyzed the impact of medication therapies on miRNA relative levels and found elevated miR-320a-3p levels in patients receiving angiotensin-converting-enzyme inhibitors (ACEI) therapy. Additionally, we found that miR-320a-3p, miR-21-5p, and miR-146a-5p plasma levels positively correlated with the CHA2DS2-Vasc score and were elevated in subjects with CHA2DS2-Vasc ≥ 2. Our results indicate that, amongst the analyzed miRNAs, miR-320a-3p may be considered as a potential PAF circulating plasma biomarker, leading to speculation as to whether this miRNA is a marker of platelet state change due to ACEI therapy.

Prevalence of left ventricular systolic dysfunction in atypical outpatient pacemaker cohort.

BackgroundRight ventricular (RV) pacing is the standard treatment for symptomatic bradycardia. RV pacing is known to cause dyssyncrony. New treatment options like His bundle pacing enhance the focus on left ventricular dysfunction in patients with pacemakers.ObjectivesThe aim of this cross-sectional study was to obtain a real-life picture of the patients in a representative cohort of outpatients with permanent pacemakers. The prevalence and causes of left ventricular dysfunction (LVD) were explored.MethodsIn total, 1869 patients of a pacemaker outpatient clinic were screened for left ventricular systolic dysfunction by transthoracic echocardiography. All patients were interviewed for symptoms and cardiologist care. Percentages of RV pacing and underlying cardiac disease were recorded.ResultsA left ventricular ejection fraction (LVEF) under 45% was found in 207 (11.1%) of all patients. Predictive factors for a reduced LVEF were a high pacing rate and long-term pacing. LVD due to RV pacing was diagnosed in 3.4% of all patients. Only 845 patients (45%) reported that they regularly visited a cardiologist.ConclusionThere is a high prevalence of unknown LVD in a typical pacemaker cohort. Therefore, regular echocardiographic examinations should be performed in outpatients of pacemaker clinics.