Presence Of Cardiovascular Disease Research Articles

MO832: Survival of Dialysis Patients With Cardiovascular Comorbidity

Abstract BACKGROUND AND AIMS Kidney disease is associated with a huge economic burden. High-income countries spend up to 2%–3% of their annual health care budget on end-stage kidney disease. Even if <0.03% of the total population receive such treatment. In 2010, 2.62 million people worldwide received dialysis, and the demand for dialysis is projected to double by 2030. The most common cause of death in patients with CKD is complications from cardiovascular disease. They are the main factor determining the decrease in the effectiveness of renal replacement therapy, especially among young and middle-aged people. Mortality from cardiovascular disease in people with end-stage CKD is 10–30 times higher than in the general population. Purpose of the work: to comparatively study the survival rates in dialysis patients, depending on the presence of cardiovascular diseases. METHOD In our study, we conducted a prospective cohort study of 210 patients (117 men and 93 women) in three different dialysis centers in Uzbekistan. The study lasted 36 months (from January 2018 to December 2020). The average age was 49.2 ± 13.8 years. The main primary diseases were glomerulonephritis (44%), diabetes mellitus (29%) and urolithiasis (7%). The duration of hemodialysis at the time of enrollment of patients in the study ranged from 6 to 172 months. Among the examined dialysis patients, 53% (n = 112) of patients (62 men and 50 women) had CVD and 47% (n = 98) of patients (52 men and 46 women) had no CVD. The main CVDs were arterial hypertension, ischemic heart disease, heart failure and various arrhythmias. Survival was determined by the Kaplan–Meier method. The [95% confidence interval (95% CI)] was determined using the Greenwood method. RESULTS After 36 months of follow-up, 43.8% (n = 92) of all patients died, 56.2% (n = 118) of patients survived (17 of them underwent kidney transplantation). When analyzing the causes of mortality, the main causes of death in dialysis patients were sudden cardiac death, acute respiratory failure, acute cerebrovascular accident, coma and acute bleeding. In dialysis patients with CVD, sudden cardiac death was 67% (n = 42) of all causes of death, while in patients without CVD, it was 57% (n = 17). The average age of the deceased (54.2 ± 1.4) was significantly higher than in patients continuing to receive HD (44.3 ± 1.1). The average duration of hemodialysis in the survivors (34.1 ± 4.7) was higher than in the deceased (27.6 ± 2.8). Upon further analysis of these patients, it was found that among the deceased patients, 70.6% (n = 65) of the patients were patients with cardiovascular diseases, and among the survivors, 54.3% (n = 64) had no cardiovascular diseases. Among those continuing to receive dialysis, there were 32.6% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within 36 months of prospective follow-up, there were 38.7% more deaths than in patients without CVD. The survival rate of patients with CVD was 0.44 (95% CI 0.33–0.51), and in patients without CVD it was 0.65 (95% CI 0.52–0.74). CONCLUSION Our scientific research has shown that >70% of dialysis patients with CKD die due to cardiovascular disease. The main place in the structure of mortality is taken by sudden cardiac death, which is the cause of death in 67% of deceased patients. Cardiovascular comorbidity adversely affects the survival of dialysis patients in Uzbekistan. In dialysis patients without cardiovascular disease in our country, the survival rate is >30% higher than in patients with CVD.

MO476: Prevalence of Symptoms in End Stage Renal Disease and Their Association With Quality of Life

Abstract BACKGROUND AND AIMS End-stage chronic renal disease (ESRD) is an irreversible disease with serious consequences for the life of the patient and perceived as a social and professional handicap. Management of ESRD therefore requires not only control of symptoms and morbidity, but also improvement in the quality of life (QoL) of these patients. Due to its wide variety of symptoms as well as the cost/dialysis patient, ESRD is one of the most expensive pathologies in the world, making it the subject of several studies. The aim of this study was to study the prevalence and influence of symptoms on the physical and mental components of the QoL in patients with ESRD, both in those on pre-dialysis as well as in those already at the stage of hemodialysis. METHOD This is a cross-sectional observational study carried out between January and April 2021. This multicenter study concerned a cohort of 245 patients with end-stage chronic renal failure on dialysis or on pre-dialysis. Upon entry into the study, a set of 17 symptoms was collected by patient interview or by patient self-administered questionnaire. Patients’ QOL was assessed using the physical (PCS) and mental (MCS) summary components of the `Kidney Disease Quality of Life Short Form’ (KDQoL SF-36). Single and multiple logistic and linear regression analyzes were used to compare symptoms and their impact on QoL between predialysis and dialysis. A P-value < .05 in a confidence interval >95% is considered statistically significant. RESULTS Among the 245 patients included, 102 were on pre-dialysis and 143 were in the hemodialysis stage. The mean age of all of our patients was 54.21 ± 11.07 years old with extremes of 19–81 years old and predominantly male (63%). Causal nephropathy was undetermined in 53% of cases; 44% of our patients had hypertension under treatment, and 38% were diabetic. The most common symptoms are sleep disorders (71%), anorexia (48%), muscle pain (26%), weight loss (26%), loss of autonomy and chest pain (21%), asthenia and then libido disorders (20%). Among our patients, 46% still had residual kidney function. Only cramps and fatigue were significantly associated with a decline in kidney function. Symptoms such as asthenia, sleep disturbances, along with restless legs syndrome and pruritus were significantly different in the two groups, being more common in dialysis patients. In univariate analysis, the comparative study of the different components of the score found a statistically significant association between the mental component of the scoring and the age, the female sex, the feeling of burden in relation to the family, the quality of dialysis (Kt/V) and pruritus. In contrast, the duration of kidney disease, loss of residual kidney function and anemia were associated with increased kidney disease burden and physical component. In multivariate analysis, the presence of cardiovascular disease increased the risk of clinically poor QoL, and age >60 years increased the risk of having poor QoL. On the contrary, having the ability to do the work at home as well as a good relationship with caregivers are factors of good QoL mentally, and seniority in HD > 5 years had a positive impact on physical QoL. CONCLUSION The QoL during ESRD is a complex notion that results from an interaction of several components: the disease itself, the patient's psychological traits, the patient's behavior in the face of his illness and social support. Despite this complexity, it must be considered as a criterion for evaluating the means of substitution offered in IRCT. Finally, the QoL after kidney transplant remains much higher than that offered by dialysis despite the risk of complications related to immunosuppressants.

TRAIL Score: A Simple Model to Predict Immunochemotherapy Tolerability in Patients With Diffuse Large B-Cell Lymphoma

Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) represents the standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). However, many patients are unable to tolerate R-CHOP and have inferior outcomes. This study aimed to develop a practical tool to help physicians identify patients with newly diagnosed DLBCL unlikely to tolerate a full course of R-CHOP. We developed a predictive model (Tolerability of R-CHOP in Aggressive Lymphoma [TRAIL]) on the basis of a training data set from the phase III GOYA trial (obinutuzumab with CHOP v R-CHOP in 1L DLBCL) using a composite binary end point, identifying patients who prematurely stopped or required reductions of R-CHOP. Candidate predictive variables were selected on the basis of known baseline characteristics that contribute to patient frailty, comorbidity, and/or chemotherapy toxicity. TRAIL was developed using an iterative trial-and-error modeling process to fit a logistic regression model. The final model was evaluated for robustness using a GOYA holdout data set and the phase III MAIN (R-CHOP with or without bevacizumab in 1L DLBCL) R-CHOP-21 data set as external validation. TRAIL includes four simple predictors available in the routine clinical setting: Charlson Comorbidity Index, presence of cardiovascular disease or diabetes, serum albumin, and creatinine clearance. Model generalization performance estimated by the area under the curve was around or above 0.70 across GOYA training, GOYA holdout, and MAIN data sets. Classifying patients into low-, intermediate- and high-risk categories, the proportion of patients experiencing a tolerability event was 3.3%, 12.4%, and 32.9%, respectively, in GOYA holdout, and 9.7%, 9.7%, and 34.2%, respectively, in MAIN. TRAIL may be useful as a clinical decision support tool for treatment decisions in patients with DLBCL who may not tolerate standard chemoimmunotherapies.

Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis.

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P < 0.01), and in women, heart failure (P < 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178.

Do recent meta-analyses truly prove that treatment with blood pressure-lowering drugs is beneficial at any blood pressure value, no matter how low? A critical review.

Current European guidelines for the management of hypertension and on cardiovascular disease prevention place the threshold for pharmacological treatment at a SBP level of 140 mmHg or above, with the exception of patients at very high risk (mainly because of coronary heart disease). This is in agreement with the current definition of hypertension, that is, the level of blood pressure at which the benefits of treatment outweigh the risks of treatment, as documented by clinical trials. This rationale and definition was recently challenged by meta-analyses using individual participant-level data from 48 randomized trials by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC). The authors calculated for a fixed 5 mmHg pharmacological reduction of SBP an overall 10% risk reduction for major cardiovascular events. It was concluded that there was no reliable evidence of heterogeneity of treatment effects by baseline SBP categories; that the effect was independent from the presence of cardiovascular disease; applied also to old and very old individuals up to 84 years or beyond; and that BP-lowering was also beneficial in individuals with normal or high-normal SBP down to a baseline SBP less than 120 mmHg. In this report, we identify and discuss a number of shortcomings of the BPLTTC meta-analyses. In our view, the conclusions by the BPLTTC must be -together with accompanying suggestions to abandon the definition of hypertension - strongly rejected as they are not justified and may be harmful for cardiovascular health in individuals without hypertension.

Correlation relationships of myocardial work indices with left ventricular ejection fraction and postsystolic strain index in healthy individuals

Abstract Funding Acknowledgements Type of funding sources: None. Purpose to identify correlations between the indicators of the global work of the left ventricular (LV) myocardium with the ejection fraction (EF) and the post-systolic contraction index (iPSI) in healthy individuals. Methods the study included 70 healthy people: 34 men and 36 women aged 21 to 61 years (mean age 39.3 ± 8.9 years). Inclusion criteria: absence of complaints, anamnestic and physical data indicating the presence of cardiovascular diseases and / or damage to other organs and systems; ECG without significant changes; lack of regular intake of any medications. Exclusion criteria: diseases of the cardiovascular system, respiratory system, kidney, liver; type 1 and 2 diabetes mellitus; chest trauma; BMI> 30 kg / m2; poor visualization of the echogram. Echocardiography was performed on a Vivid GE 95 Healthcare scanner (USA). EchoPAC software version 202 (GE Healthcare) has been used. LVEF has been determined by the Simpson biplane method. The index of global myocardial work (GWI, mmHg%), global constructive work (GCW, mmHg%), global wasted work (GWW, mmHg%), global work efficiency have been assessed in automatic mode. (GWE,%). The iPSS and the number of segments, the PSS index of which was more than 1, have been automatically determined. Spearman"s correlation coefficient (r) has been used to study the relationship between quantitative traits. Results indicators of global myocardial work had the following values: GWE - 97.5 (97; 98)%; GWI - 2062.6 ± 345.5 mm Hg%; GCW - 2353.3 ± 344.6 mm Hg%; GWW - 45 (32; 68) mm Hg%. LVEF on average 60.8 ± 4.6%, iPSS - 1.35 (0.73; 2.35). The average number of segments with iPSS> 1 - 4 (3; 6) (26.5%). The correlation coefficient of LVEF with GCW was 0.49 (p = 0.00001), with GWI - 0.45 (p = 0.00007), with GWE - 0.25 (p = 0.032), with GWW - (-0 , 19) (p = 0.1). Correlation coefficient of iPSS with indicators of myocardial work: with GWE - (-0.85) (p = 0.0007), with GWW - 0.85 (p = 0.00004), with GCW - (-0.05) (p = 0.68), with GWI - 0.07 (p = 0.5). When determining the relationship between the number of segments with iPSS> 1 and GWE, the correlation coefficient was 0.46 (p = 0.0002), with GWW - 0.57 (p = 0.0003), with GWI - 0.26 (p = 0 , 03), with GCW - 0.12 (p = 0.3). Conclusions GCW and GWI had moderate positive correlations with LVEF. GWE and GWW had a strong relationship with iPSS and moderate correlations with the number of segments with iPSS> 1.

Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda

BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure.MethodsWe measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status.ResultsOf 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT.ConclusionsImpaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.

Cardiovascular Diseases in Pregnancy - A Brief Overview.

Even though, there have been many advances in maternal medical care and fertility treatments, the presence of cardiovascular disease has a significant impact on pregnancy. In pregnant women, several heart conditions, such as valvular heart disease, chronic hypertension, congenital heart defects and non-ischemic cardiomyopathies are linked to increased risk of fetal as well as maternal morbidity and mortality. To date, the management of the co-existing conditions of pregnancy and heart disease has been challenging. Therefore, in-depth information may be beneficial to tackle a difficult case scenario. Towards this end, this paper provides an overview of the recent updated knowledge of pregnancy-related cardiovascular diseases in women.

Unfavorable effect of high postoperative fluid balance on outcome of pancreaticoduodenectomy.

PurposeDespite the many efforts to overcome postoperative complications, pancreaticoduodenectomy (PD) is still accompanied with considerable concerns of lethal complications. The clinical factors are known to affect postoperative outcomes such as diameter of pancreatic duct, texture of pancreas, and comorbidity of the patients are mostly uncorrectable. Thus, investigation for correctable risk factors is required. Recently, perioperative fluid volume was reported to be associated with complications after PD. This study aims to determine the relationship between postoperative fluid balance and surgical outcome after open PD.MethodsWe reviewed, retrospectively, 172 consecutive patients who underwent open PD in a single institution between 2015 and 2019. The status of perioperative fluid balance 2 days after surgery and clinical factors were investigated to determine the association with postoperative outcome including postoperative pancreatic fistula (POPF). According to postoperative fluid balance, patients were divided into high- and low-balance groups, and clinical features and surgical outcomes were compared between both groups. Multivariate analysis were performed to identify risk factors for POPF.ResultsThe percentage of morbidity and the incidence of POPF were higher in the high-balance group compared to the low-balance group (61.6% vs. 37.2%, P = 0.001; 15.1% vs. 3.5%, P = 0.009). High postoperative fluid balance and the presence cardiovascular disease were correlated with POPF on multivariate analysis (odds ratio [OR], 4.574; 95% confidence interval [CI], 1.229–17.029; P = 0.023 and OR, 3.517; 95% CI, 1.209–12.017; P = 0.045).ConclusionHigher amount of postoperative fluid balance and the presence of cardiovascular disease are associated with POPF after PD.

Practical Risk Scoring System for Predicting Severity of COVID-19 Disease.

Objectives:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 disease, has become an international pandemic with numerous casualties. It had been noted that the severity of the COVID-19 disease course depends on several clinical, laboratory, and radiological factors. This has led to risk scoring systems in various populations such as in China, but similar risk scoring systems based on the American veteran population are sparse, particularly with the vulnerable Veteran population. As a simple risk scoring system would be very useful, we propose a simple Jhala Risk Scoring System (JRSS) to assess the severity of disease risk.Methods:A retrospective review of all SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) tests collected and performed at the regional Veterans Administration Medical Center (VAMC) serving the Philadelphia and surrounding areas from March 17th, 2020 to May 20th, 2020. Data was collected and analyzed in the same year. These tests were reviewed within the computerized medical record system for demographic, medical history, laboratory test history, and clinical course. Information from the medical records were then scored based on the criteria of the Jhala Risk Scoring System (JRSS).Results:The JRSS, based on age, ethnicity, presence of any lung disease, presence of cardiovascular disease, smoking history, and diabetes history with laboratory parameters correlated and predicted (with statistical significance) which patients would be hospitalized.Conclusion:The JRSS may play a role in informing which COVID-19 positive patients in the emergency room/urgent care for risk stratification.

The Prevalence of Acute Respiratory Distress Syndrome (ARDS) and Outcomes in Hospitalized Patients with COVID-19-A Study Based on Data from the Polish National Hospital Register.

Acute respiratory distress syndrome (ARDS) is a serious complication of COVID-19. This study aimed to evaluate the prevalence of ARDS among patients hospitalized with COVID-19 in Poland as well as to characterize clinical outcomes in patients hospitalized with COVID-19-associated ARDS. This is a retrospective, secondary analysis of epidemiological data from 116,539 discharge reports on patients hospitalized with COVID-19 in Poland between March and December 2020. The overall prevalence of ARDS was 3.6%, respectively 2.9% among females, and 4.4% among males (p < 0.001). Of the 4237 patients hospitalized with COVID-19-associated ARDS, 3764 deaths were reported (88.8%). Participants aged 60 years and over had more than three times higher odds of COVID-19-associated ARDS. Men had higher odds of COVID-19-associated ARDS than women (OR = 1.55; 95% CI: 1.45–1.65; p < 0.001). Patients with COVID-19 and diabetes had higher odds of COVID-19-associated ARDS (OR = 1.16; 95% CI: 1.03–1.30; p = 0.01). Among patients with COVID-19-associated ARDS, older age, male sex (OR = 1.27; 95% CI: 1.03–1.56; p = 0.02), and presence of cardiovascular diseases (OR = 1.26; 95% CI: 1.00–1.59; p = 0.048) were significantly associated with the risk of in-hospital death. Among patients hospitalized with COVID-19 in Poland, the prevalence of ARDS was relatively low, but the in-hospital mortality rate in patients with COVID-19-associated ARDS was higher compared to other EU countries.

Clinical Characteristics Predicting Mortality Risk in Hospitalized Geriatric Patients with COVID-19 Pneumonia: a Retrospective Study

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Geriatric patients with COVID-19 are more likely to progress to severe disease, and they are at increased risk of hospitalization and mortality. In this study we aimed to investigate the risk factors for predicting mortality in geriatric patients with COVID 19 by reviewing the clinical data of survivors and non-survivors. This was a retrospective study of 189 geriatric patients with COVID- 19 pneumonia who were hospitalized in pulmonology clinic, in Duzce University, Medical Faculty Hospital between March 2020 and January 2021 in Turkey. In the study, 60.3% (n = 114) of the patients were male and the median age was 75. 80.4% (n = 152) of the patients were discharged. The presence of cardiovascular disease, chronic renal failure, malignancy, increased number of comorbidities, complaints of anorexia, no fever, decreased oxygen saturation value, increased pulse rate, high values of maximum (max) D-dimer, aspartate aminotransferase, urea, creatinine, troponin, lactate dehydrogenase (LDH), max LDH, ferritin and max ferritin, C-reactive protein (CRP), max CRP, procalcitonin, max procalcitonin, potassium values and low albumin values, complications as bacterial infection, cardiac disease, acute respiratory distress syndrome, liver function tests failure, arrhythmia and shock, the need for corticosteroid and pulse corticosteroid therapy increased the mortality. According to multiple logistic regression model, the de-velopment of cardiac disease, acute respiratory distress syndrome, bacterial infection, the need for pulse steroids, and the max ferritin value increased the risk of mortality by between 1.001 and 28.715 times. Both clinical and laboratory parameters predicting mortality in geriatric patients with COVID-19 pneumonia should be monitored very carefully. Complications that develop should be evaluated and multidisciplinary and necessary treatments should be initiated without delay.

The effect of therapy on subclinical atherosclerosis of the carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study)

Endothelial dysfunction associated with chronic microcrystalline inflammation plays a role in the progression of atherosclerosis in calcium pyrophosphate crystal deposition diseases (CPPD).The aim of the study was to assess the dynamics of the development of atherosclerosis based on changes in the thickness of the intima-media complex (ICIM) of the carotid arteries (CA) in patients with CPPD receiving long-term anti-inflammatory therapy (colchicine, methotrexate, hydroxychloroquine).Materials and methods. 26 patients with CPPD and 26 patients with osteoarthritis aged over 18 years old were included. Exclusion criteria: age &gt;65 years; presence of cardiovascular diseases. The blood lipid spectrum, hs-CRP level, anthropometric parameters were determined for all, and Doppler ultrasound ultrasonography of the carotid arteries (CA) was performed. Patients were followed up for not &lt;6 months, assessed ICIM CA at 1 visit, then patients with CPPD, at the discretion of the attending physician, were prescribed methotrexate at a dose of 15 mg per week, hydroxychloroquine 200 mg 1 time per day or colchicine 0.5 mg 2 times a day. Patients could take NSAIDs if they were in pain. The SCORE index has been calculated for everyone.Results. Initially, ICIM values did not differ in patients with CPPD and OA. Initially, ICIM&gt;0.9 mm were detected in 11 of 22 (50%) patients with CPPD and in OA in 8 of 19 (42%) (p=0.39). In dynamics, patients with CPPD revealed a decrease in the number of patients with ICIM&gt;0.9 mm from 42 to 18%. At the same time, in 8 patients with CPPD, ICIM&gt;0.9 mm was combined with a CRP level &gt;0.2 mg/l. Out of 22 patients with CPPD, 14 (64%) patients showed a decrease in the mean values of ICIM, in 2 (9%) patients - an increase, in 5 patients the mean values of ICIM did not change. After 6 months of therapy, out of 11 patients with CPPD with ICIM &gt;0.9 mm, after 6 months of therapy, in 7 cases there was a decrease in the indicator less than the specified value, in 5 of them a decrease in serum CRP level &lt;2 mg/l was recorded. In patients with CPPD, the serum CRP level significantly decreased; in patients with OA, it did not change. Out of 19 patients with OA, 9 (47%) patients showed an increase in the mean ICIM over time, while the rest did not change. In those treated with hydroxychloroquine, a decrease in the mean ICIM parameters was observed in 5 out of 6 (83%) patients, colchicine - in 6 out of 9 (67%) patients, methotrexate - in 4 out of 7 (57%) patients.With CPPD, the result of therapy with colchicine, methotrexate and hydroxychloroquine in relation to the development of the initial signs of atherosclerosis according to Doppler ultrasound ultrasonography of CA can be realized based on the presence of chronic inflammation.

Screening of Depressive Symptoms in a Russian General Population Sample: A Web-based Cross-sectional Study.

Background and Objective:Web-based screening of depressive symptoms in general non-clinical population can provide better insights into actual prevalence of depressive symptoms and associated risk factors. To study the current prevalence of depressive symptoms in Russian non-clinical population we conducted screening using an online survey based on Depression subscale of Hospital Anxiety and Depression Scale (HADS-D).Methods:The online survey covered 2610 Russian-speaking respondents and included HADS-D, questions about sex, age and presence of cardiovascular diseases (CVD) diagnoses or symptoms in respondents.Results:The proportion of respondents with depressive symptoms, estimated by online HADS-D, was 14.4% (11.5% - at subclinical level, 2.9% - at clinical level). The overall HADS-D score was higher in women (p=0.003), in young individuals under 30 y.o vs. participants over 42 y.o. (p=0.004) and in individuals with self-reported CVD symptoms (p=0.00002). Linear regression analysis showed that self-reported CVD symptoms increase HADS-D score (p<0.001), but male sex (p=0.002) and older age (p<0.001) decrease it. Logistic regression showed that CVD symptoms increase the risk of depressive symptoms by HADS-D (p=0.033, OR=1.29), but older age (p=0.015, OR=0.87) and male sex (as a trend, p=0.052, OR=0.80) decrease this risk.Conclusion:Online survey based on HADS-D showed new patterns of depressive symptoms prevalence in Russian non-clinical population. Depressive symptoms prevalence did not differ between men and women and was higher among young people. The reported association between depressive symptoms and CVD was confirmed.

Can body shape index indicate obesity-associated inflammation and cardiovascular diseases in stage 3-4 chronic kidney disease patients?

The incidence and prevalence of obesity are increasing rapidly throughout the world. Various methods have been developed to evaluate obesity. A body shape index (aBSI) is based on waist circumference adjusted for height and weight. High BSI values have been found to be associated with early mortality. It is known that obesity is associated with inflammation and cardiovascular diseases. In this study, we examined the relationship between aBSI, inflammatory markers such as C-reactive protein and interleukin-6 and cardiovascular disease in patients with stage 3-4 chronic kidney disease.&#x0D; Methods. One hundred twenty patients were enrolled in this cross-sectional observational study. The mean aBSI value was 0.0870. Patients were divided into 2 groups according to the mean value of aBSI as there is no currently defined cut-off value for BSI. Those with aBSI ≤ 0.087 were allocated to group I, and those with aBSI&gt; 0.0870 to group II.&#x0D; Results. Patients in group II had more cardiovascular disease than in group I. In partial Spearman correlation analysis, the presence of cardiovascular disease was correlated with aBSI (r = 0.36, p = 0.0001). aBSI higher than 0.0986 predicted cardiovascular disease in our cohort: the area under the curve (CI 95%) for aBSI was 0.715 (0.602-0.829).&#x0D; Conclusions. The relationship between aBSI and inflammation could not be shown. But we found that high aBSI is associated with increased cardiovascular disease. Further studies are needed to recommend the routine clinical use of aBSI as a cardiovascular disease marker.

Individualización del tratamiento de la diabetes mellitus tipo 2

The rising incidence of type 2 diabetes mellitus (DM2) nowadays represents a true public health problem and there is a need to improve this disease's prognosis. In recent years, a glucocentric treatment approach has progressively been abandoned, giving way to a comprehensive approach to the patient that allows for the individualization of treatment, given the high degree of heterogeneity among diabetic patients. In this regard, multiple aspects must be considered when choosing a treatment (age, life expectancy, patient preferences, etc.). However, nowadays, the presence of cardiovascular disease, chronic kidney disease, or heart failure condition treatment choice to a great extent, given the cardiovascular benefits obtained from new families of antidiabetic drugs (GLP-1 receptor agonists and SGLT2 inhibitors).

Epidemiological profile of covid-19 in the state of espírito santo, brazil, from march 2020 to june 2021

Introduction: coronavirus 2019 Disease (COVID-19) was quickly declared a pandemic, and Brazil is facing the most significant health and hospital crisis in its history. From March to June 2021 represented 50.8% of all deaths in the State of Espirito Santo.&#x0D; Objective: to analyze the lethality and mortality by COVID-19 in the State of Espirito Santo from March 2020 to June 2021.&#x0D; Methods: an ecological study was carried out, using a time series of public and official data available on the Health Department of the State of Espirito Santo, Brazil. Were considered information about cases and deaths (from March 2020 to June 2021) of COVID-19. Percentage case-fatality and mortality and incidence rates per 100,000 population were calculated. Time-series analyses were performed using the Prais-Winsten regression model, estimating the Daily Percent Change (DPC), and the trends were classified as flat, increasing, or decreasing. Significant differences were considered when p&lt;0.05.&#x0D; Results: 524,496 confirmed cases of COVID-19 as of June 30, 2021, and 11,516 progressed to death. The presence of cardiovascular diseases represents more than half of confirmed comorbidities (54.37%) in patients with COVID-19, followed by diabetes (19.95%) and obesity (9.34%). Men had higher mortality and lethality, especially in older age groups, but the incidence was higher among women. A characteristic profile of two waves was observed; the first wave was extended from March to October 2020 and the second complete wave from November 2020 to June 2021. During the second wave, high peaks of incidence, lethality, and mortality were recorded. At the end of the second wave, the incidence rate remained with increasing trends (p &lt; 0.05), with a DPC of 2.06%.&#x0D; Conclusion: the peak concentration of cases, deaths, and indicators of lethality, mortality evidenced even after one year of pandemic, characterizes the severity of the COVID-19 pandemic, still in entire evolution in the State Espirito Santo and Brazil.

Predicting the clinical outcomes and benefit from letrozole after 5years of treatment with aromatase inhibitors for early breast cancer: analysis from CCTG MA.17R.

Women with hormone receptor positive breast cancer may receive 5years of treatment with aromatase inhibitors but the magnitude of benefit was relatively small. Our goal was to develop a tool for identification of women with limited treatment benefit. Regression analyses were applied to women treated by placebo in CCTG MA.17R trial (NCT00754845) to identify important prognostic factors associated with distant recurrence and develop a nomogram for predicting 5-year likelihood of distant recurrence, which was internally validated using bootstrap resampling method. Differential treatment effects between risk categories derived from the nomogram were evaluated among all women enrolled through interaction test between treatment and risk category. A total of 1735 women were included and the final model from 866 women treated by placebo identified the following three factors associate with distant recurrence: tumor size, nodal status, and presence of cardiovascular disease. The nomogram derived from the final model exhibited good discrimination power with a bootstrap-corrected concordance index of 0.71 and, importantly, identified 64% of low risk patients in whom extended treatment has limited benefit. Interaction between treatment and risk category derived from the nomogram was significant (p = 0.04). A nomogram with good performance may be used to accurately predict distant recurrence risk and also benefits with extended treatment after 5years of aromatase inhibitors. Future independent validation of the proposed nomogram is warranted. NCT00754845.

Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states?

To determine risk factors for death in patients with coronavirus disease 2019 (COVID-19) admitted to the main hospital in Somalia, and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. A survival analysis was conducted of all patients with COVID-19 admitted to the main hospital in Somalia from 30 March to 12 June 2020. Of the 131 patients admitted to the hospital with COVID-19, 52 (40%) died and 79 (60%) survived. The main factors associated with the risk of in-hospital death were age ≥60 years{survival probability on day 21 was 0.789 [95%confidence interval (CI) 0.658-0.874] in patients aged <60 years vs 0.339 (95% CI 0.205-0.478) in patients aged ≥60 years}, cardiovascular disease [survival probability 0.478 (95% CI 0.332-0.610) in patients with cardiovascular disease vs 0.719 (95% CI 0.601-0.807) in patients without cardiovascular disease] and non-invasive ventilation on admission(patients who were not ventilated but received oxygen were significantly more likely to survive than patients who were ventilated; P<0.001). Considering the risk factors (age ≥60 years, presence of cardiovascular disease and use of non-invasive ventilation) is critical when managing patients with severe COVID-19, especially in low-resource settings where availability of skilled healthcare workers for critical care units is limited. These findings also highlight the importance of use of medical oxygen for severely ill patients, and the critical aspect of deciding whether or not to ventilate critical patients with COVID-19 in order to improve clinical outcome.

Practical Risk Scoring System for Predicting Severity of COVID-19 Disease

Introduction/ObjectiveSARS-CoV-2 has become an international pandemic with numerous casualties. The severity of the COVID-19 disease course depends on several clinical, laboratory, and radiological factors. This has led to risk scoring systems in various populations such as in China, but similar risk scoring systems developed based on the American veteran population are sparse. As a risk scoring system (RSS) would be very useful for future reference in similar pandemics, we share a simple Jhala Risk Scoring System (JRSS) developed early in the pandemic to assess the severity of disease risk.Methods/Case ReportA retrospective review of all SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) tests collected and performed at the regional Veterans Administration Medical Center (VAMC) serving the Philadelphia and surrounding areas from March 17th, 2020 to May 20th, 2020. Data was collected and analyzed in the same year. These tests were reviewed within the computerized medical record system for demographic, medical history, laboratory test history, and clinical course. Information from the medical records were then scored based on the criteria of the JRSS.Results (if a Case Study enter NA)The JRSS, based on age, ethnicity, presence of any lung disease, presence of cardiovascular disease, smoking history, and diabetes history with laboratory parameters correlated and predicted (with statistical significance) which patients would be hospitalized.ConclusionThe JRSS reached statistical significance in its predictions on informing risk stratification for COVID-19 positive patients. Similar risk scoring systems may play a role in the rapid development of risk scoring in future pandemics of similar nature and thus provide a useful reference point. A simple RSS based on clinical parameters is a highly practical, cost effective and simple system to evaluate need for hospitalization, which is critical for operations in the intensive care unit and simultaneously the use of ventilators.