Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
This document discusses the management of cardiovascular disease (CVD) during the COVID-19 pandemic. It notes that CVD patients have a higher risk of severe COVID-19 and complications. While the symptoms of CVD and COVID-19 can be similar, timely management of CVD emergencies is important. The document recommends a pharmacoinvasive strategy over primary PCI for STEMI patients when possible. It also provides guidance on managing other conditions like NSTEMI, heart failure and arrhythmias during the pandemic. Telemedicine is encouraged for stable patients to reduce hospital visits and risk of COVID-19 exposure.
A 58-year-old woman was admitted with COVID-19 symptoms and developed cardiogenic and septic shock. An echocardiogram showed findings consistent with takotsubo cardiomyopathy - also known as stress cardiomyopathy - with left ventricular dysfunction. Her left ventricular function improved over the next few days, supporting the diagnosis of reversible acute stress cardiomyopathy secondary to COVID-19. This is the first reported case of takotsubo cardiomyopathy associated with COVID-19 in the United States.
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
This document provides guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in adults. It addresses 12 questions regarding best practices for diagnosis and management of CAP in both outpatient and inpatient settings. For each question, the document reviews the relevant evidence and provides treatment recommendations based on that evidence. The recommendations aim to optimize patient outcomes while minimizing unnecessary testing and promoting judicious antibiotic use.
Post covid pulmonary fibrosis , atypical covid19 sequeleDr-Ajay Tripathi
1) COVID-19 can cause persistent radiological changes and lung function abnormalities even after discharge from the hospital. Regular follow-up is recommended, especially for severe cases.
2) COVID-19 has been shown to cause multi-system involvement beyond the lungs, including cardiovascular, neurological, renal and other organ systems. It can present atypically without respiratory symptoms.
3) Post-COVID care including pulmonary rehabilitation is important as many patients have long-term effects. Emerging treatments like anti-fibrotics are being studied to prevent long-term pulmonary fibrosis in severe cases.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
This document discusses the management of cardiovascular disease (CVD) during the COVID-19 pandemic. It notes that CVD patients have a higher risk of severe COVID-19 and complications. While the symptoms of CVD and COVID-19 can be similar, timely management of CVD emergencies is important. The document recommends a pharmacoinvasive strategy over primary PCI for STEMI patients when possible. It also provides guidance on managing other conditions like NSTEMI, heart failure and arrhythmias during the pandemic. Telemedicine is encouraged for stable patients to reduce hospital visits and risk of COVID-19 exposure.
A 58-year-old woman was admitted with COVID-19 symptoms and developed cardiogenic and septic shock. An echocardiogram showed findings consistent with takotsubo cardiomyopathy - also known as stress cardiomyopathy - with left ventricular dysfunction. Her left ventricular function improved over the next few days, supporting the diagnosis of reversible acute stress cardiomyopathy secondary to COVID-19. This is the first reported case of takotsubo cardiomyopathy associated with COVID-19 in the United States.
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
This document provides guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) in adults. It addresses 12 questions regarding best practices for diagnosis and management of CAP in both outpatient and inpatient settings. For each question, the document reviews the relevant evidence and provides treatment recommendations based on that evidence. The recommendations aim to optimize patient outcomes while minimizing unnecessary testing and promoting judicious antibiotic use.
Post covid pulmonary fibrosis , atypical covid19 sequeleDr-Ajay Tripathi
1) COVID-19 can cause persistent radiological changes and lung function abnormalities even after discharge from the hospital. Regular follow-up is recommended, especially for severe cases.
2) COVID-19 has been shown to cause multi-system involvement beyond the lungs, including cardiovascular, neurological, renal and other organ systems. It can present atypically without respiratory symptoms.
3) Post-COVID care including pulmonary rehabilitation is important as many patients have long-term effects. Emerging treatments like anti-fibrotics are being studied to prevent long-term pulmonary fibrosis in severe cases.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
The document discusses COVID-19 and its impact on the cardiovascular system. It covers the epidemiology of COVID-19 and how it can lead to myocardial infarction through several pathways. The pathophysiology involves three phases - early infection, pulmonary, and hyperinflammation - that can result in direct myocardial injury, cytokine storm, or stress-induced cardiomyopathy. Those at highest risk are the elderly, those with pre-existing cardiovascular conditions, and those with other comorbidities. Assessment of cardiac issues in COVID-19 patients involves evaluating symptoms like chest pain and dyspnea, as well as diagnostic tests. Management depends on the specific cardiovascular presentation, such as protocols for STEMI patients or those with cardiogenic shock.
This document reviews 13 cases of acute mesenteric ischemia (AMI) in COVID-19 patients identified from a literature review. The median age was 56 years and most patients presented with abdominal pain, though timing of AMI diagnosis varied from 1-13 days after COVID-19 symptoms. Imaging showed thrombosis in mesenteric arteries in most cases. Treatment included surgery or anticoagulation, and 4 patients died. The review discusses the potential pathological mechanisms for AMI in COVID-19 patients like endothelial inflammation, coagulation abnormalities, and cytokine storm effects.
COVID-19 can cause cardiac injury through several mechanisms. It can cause acute heart failure, myocarditis, and exacerbate existing hypertension. Patients with COVID-19 should receive standard thromboprophylaxis and be monitored for potential pulmonary embolism. Drug interactions between antiviral treatments and other medications need to be considered, especially those that may prolong the QT interval. General advice for cardiac patients during the pandemic includes following social distancing measures and seeking medical care if new symptoms develop.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
1) The study investigated the relationship between body temperature (Tb) abnormalities and disease severity and outcomes in 624 patients with severe sepsis.
2) Patients with hypothermia (Tb ≤36.5°C) had significantly higher organ failure scores, illness severity scores, rates of disseminated intravascular coagulation, and 28-day and hospital mortality compared to patients without hypothermia (Tb >36.5°C).
3) Hypothermia was found to be an independent predictor of increased 28-day mortality in patients with severe sepsis, irrespective of whether they had septic shock.
Network pharmacology studies on the effect of Chai-Ling decoction in coronavi...LucyPi1
Abstract Background: Chai-Ling decoction (CLD), derived from a modification of Xiao-Chai-Hu (XCH) decoction and Wu-Ling-San (WLS) decoction, has been used to treat the early-stage of coronavirus disease 2019 (COVID-19). However, the mechanisms of CLD in COVID-19 remain unknown. In this study, the potential mechanisms of CLD in COVID-19 were preliminarily investigated based on network pharmacology and molecular docking method. Methods: Initially, the active components and targets of CLD were screened based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and PharmMapper database. The targets of COVID-19 were obtained from GeneCards database. The protein-protein interaction network was established using STRING database to analyze the key targets. Gene Oncology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes analysis were also conducted to evaluate the pathways related to the targets of CLD on COVID-19. Moreover, the compound-target-pathway network was established using Cytoscape 3.2.7. Subsequently, the molecular docking method was performed to select the active compounds with high binding affinity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2), which is the key target of SARS-CoV-2 in entering target cells. The possible binding sites were also visualized by a three-dimensional graph. Results: Network pharmacology analysis showed that there were 106 active components and 160 targets of CLD. Additionally, 251 targets related to COVID-19 were identified, and 24 candidates of CLD on COVID-19 were selected. A total of 283 GO terms of CLD on COVID-19 were identified, and 181 pathways were screened based on GO and Kyoto Encyclopedia of Genes and Genomes analyses. CLD might alleviate the inflammatory response and improve lung injury to treat COVID-19 through interleukin 17 signaling, T helper cell 17 differentiation, tumor necrosis factor signaling, and hypoxia inducible factor-1 signaling. Besides, molecular docking indicated that beta-sitosterol, kaempferol, and stigmasterol were the top three candidates in CLD with the highest affinity to SARS-CoV-2 and ACE2. Conclusion: Our study identifies the potential mechanisms of CLD on COVID-19 and beta-sitosterol, kaempferol, and stigmasterol may be the key compounds that exert antiviral effects against SARS-CoV-2.
This document discusses biomarkers in scleroderma and their potential uses. It defines biomarkers as measurable indicators of biological processes related to health and disease. Biomarkers could help predict disease progression and treatment response. The document reviews potential biomarkers related to skin involvement, lung fibrosis, renal disease, and pulmonary arterial hypertension in scleroderma. It highlights how biomarkers may help identify patients at high risk of organ complications who could benefit from early treatment or clinical trial enrollment.
This document provides a CV for Professor Gamal Mohamed Rabie Agmy, including his contact information, educational background, positions held, supervision of scientific theses, scientific researches, and scientific awards. He holds a Professor position of chest diseases and respiratory ICU at Assiut University Faculty of Medicine in Egypt. His CV outlines his educational qualifications including degrees in medicine, chest diseases, and lectureships and professorships. It also lists his supervision of 20 theses and over 70 scientific researches presented at various conferences. He has received several scientific awards for his research.
This document discusses the cardiovascular manifestations and effects of COVID-19. Some key points:
- Cardiovascular disease is a common comorbidity in patients with COVID-19, SARS, and MERS. Myocardial injury is independently associated with high mortality in COVID-19 patients.
- SARS-CoV-2 binds to ACE2 receptors, which are highly expressed in heart, blood vessels and other organs. This disrupts the balance between protective and deleterious RAAS pathways.
- COVID-19 can cause direct damage to heart through ACE2 downregulation and indirect damage from cytokine release/coagulopathy. This leads to complications like myocarditis, heart failure, arrhythmias and
This document discusses the management of sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by infection and an acute change in the SOFA score of greater than 2 points due to infection. Septic shock is a subset of sepsis with circulatory and metabolic abnormalities increasing the risk of mortality. The management of sepsis involves early fluid resuscitation, administration of broad-spectrum antibiotics within 1 hour, and vasopressors for hypotension unresponsive to fluids.
Scleroderma Associated Lung Disease is presented by
Jane Dematte MD, MBA, Director, ILD program
Division of Pulmonary and Critical Care, Northwestern Feinberg School of Medicine
This document describes a case of fulminant myocarditis likely caused by COVID-19 infection in a 59-year-old woman. Key points:
- The patient presented with fever and chest pain but no respiratory symptoms. Tests confirmed SARS-CoV-2 infection and showed signs of cardiac injury.
- Echocardiograms showed myocardial thickening, edema, and dysfunction. She deteriorated into cardiogenic shock requiring interventions.
- Treatment for suspected acute myocarditis included immunoglobulins, steroids, and antivirals. Cardiac function improved but she required ongoing ECMO support for respiratory issues.
- This case suggests that in rare cases, COVID-19 can cause severe myocarditis
This document discusses anticoagulant use in COVID-19 patients. It notes that COVID-19 can cause a pro-coagulative state through endothelial dysfunction and cytokine storm, increasing thrombotic risk. Major guidelines recommend considering anticoagulants for hospitalized COVID-19 patients at high risk of thrombosis. For non-hospitalized patients, anticoagulants are not routinely recommended unless other indications exist. The document reviews evidence and recommendations on anticoagulant dosing, duration, and considerations in special populations.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high costs, morbidity, and mortality. They result in enormous healthcare expenditures and lost productivity. AECOPD episodes are also linked to accelerated long-term loss of lung function in continuous smokers. While symptoms may recover within a week, full recovery of health-related quality of life can take months. Noninvasive mechanical ventilation should be tried for patients with respiratory acidosis or increased work of breathing from AECOPD as it reduces intubation rates and improves health outcomes. Preventing and properly managing AECOPD is important for reducing its impacts.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
Prednisolone and Mycobacterium indicus pranii in Tuberculous Pericarditis (IMPI) was a randomized controlled trial that investigated whether adjunctive prednisolone or M. indicus pranii injections improved outcomes in 1,400 patients with tuberculous pericarditis, many of whom also had HIV. The trial found no significant difference in the primary outcome but prednisolone reduced the risk of constrictive pericarditis and hospitalization. However, prednisolone and M. indicus pranii both significantly increased the risk of cancer in these immunosuppressed patients.
Antibiotics for Acute Exacerbztions of COPD Ashraf ElAdawy
This document discusses the appropriate use of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD). It states that while steroids and bronchodilators are well-established treatments for exacerbations, there is ongoing debate around antibiotic use. Antibiotics are recommended for moderate to severe exacerbations with increased cough and sputum purulence as this indicates likely bacterial infection. Sputum culture alone should not determine antibiotic use, and severity factors like purulence, underlying lung function, age and comorbidities should guide treatment decisions. Antibiotics may reduce mortality and treatment failure when targeted at patients with bacterial exacerbations.
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptxNasir Sagar
High Blood pressure has multiple adverse reaction on different body system and its proper management causes beneficial effect in multiple co morbid condition.
Approach to young hypertensive patientsChandan Kumar
1. The document discusses hypertension in young adults, including definitions of different types of elevated blood pressure (e.g. hypertensive urgency, emergency), risk factors, clinical presentation, causes (primary vs. secondary), evaluation approach, and ambulatory blood pressure monitoring.
2. Most young adults with hypertension have primary/essential hypertension with no identifiable cause, though secondary hypertension can occur in about 10% of cases. Evaluation aims to confirm the diagnosis, assess cardiovascular risk, detect target organ damage, and identify secondary causes.
3. Ambulatory blood pressure monitoring provides blood pressure readings outside the office and can help identify white coat hypertension or masked hypertension, which have implications for risk stratification and treatment.
The document discusses COVID-19 and its impact on the cardiovascular system. It covers the epidemiology of COVID-19 and how it can lead to myocardial infarction through several pathways. The pathophysiology involves three phases - early infection, pulmonary, and hyperinflammation - that can result in direct myocardial injury, cytokine storm, or stress-induced cardiomyopathy. Those at highest risk are the elderly, those with pre-existing cardiovascular conditions, and those with other comorbidities. Assessment of cardiac issues in COVID-19 patients involves evaluating symptoms like chest pain and dyspnea, as well as diagnostic tests. Management depends on the specific cardiovascular presentation, such as protocols for STEMI patients or those with cardiogenic shock.
This document reviews 13 cases of acute mesenteric ischemia (AMI) in COVID-19 patients identified from a literature review. The median age was 56 years and most patients presented with abdominal pain, though timing of AMI diagnosis varied from 1-13 days after COVID-19 symptoms. Imaging showed thrombosis in mesenteric arteries in most cases. Treatment included surgery or anticoagulation, and 4 patients died. The review discusses the potential pathological mechanisms for AMI in COVID-19 patients like endothelial inflammation, coagulation abnormalities, and cytokine storm effects.
COVID-19 can cause cardiac injury through several mechanisms. It can cause acute heart failure, myocarditis, and exacerbate existing hypertension. Patients with COVID-19 should receive standard thromboprophylaxis and be monitored for potential pulmonary embolism. Drug interactions between antiviral treatments and other medications need to be considered, especially those that may prolong the QT interval. General advice for cardiac patients during the pandemic includes following social distancing measures and seeking medical care if new symptoms develop.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
1) The study investigated the relationship between body temperature (Tb) abnormalities and disease severity and outcomes in 624 patients with severe sepsis.
2) Patients with hypothermia (Tb ≤36.5°C) had significantly higher organ failure scores, illness severity scores, rates of disseminated intravascular coagulation, and 28-day and hospital mortality compared to patients without hypothermia (Tb >36.5°C).
3) Hypothermia was found to be an independent predictor of increased 28-day mortality in patients with severe sepsis, irrespective of whether they had septic shock.
Network pharmacology studies on the effect of Chai-Ling decoction in coronavi...LucyPi1
Abstract Background: Chai-Ling decoction (CLD), derived from a modification of Xiao-Chai-Hu (XCH) decoction and Wu-Ling-San (WLS) decoction, has been used to treat the early-stage of coronavirus disease 2019 (COVID-19). However, the mechanisms of CLD in COVID-19 remain unknown. In this study, the potential mechanisms of CLD in COVID-19 were preliminarily investigated based on network pharmacology and molecular docking method. Methods: Initially, the active components and targets of CLD were screened based on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and PharmMapper database. The targets of COVID-19 were obtained from GeneCards database. The protein-protein interaction network was established using STRING database to analyze the key targets. Gene Oncology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes analysis were also conducted to evaluate the pathways related to the targets of CLD on COVID-19. Moreover, the compound-target-pathway network was established using Cytoscape 3.2.7. Subsequently, the molecular docking method was performed to select the active compounds with high binding affinity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2), which is the key target of SARS-CoV-2 in entering target cells. The possible binding sites were also visualized by a three-dimensional graph. Results: Network pharmacology analysis showed that there were 106 active components and 160 targets of CLD. Additionally, 251 targets related to COVID-19 were identified, and 24 candidates of CLD on COVID-19 were selected. A total of 283 GO terms of CLD on COVID-19 were identified, and 181 pathways were screened based on GO and Kyoto Encyclopedia of Genes and Genomes analyses. CLD might alleviate the inflammatory response and improve lung injury to treat COVID-19 through interleukin 17 signaling, T helper cell 17 differentiation, tumor necrosis factor signaling, and hypoxia inducible factor-1 signaling. Besides, molecular docking indicated that beta-sitosterol, kaempferol, and stigmasterol were the top three candidates in CLD with the highest affinity to SARS-CoV-2 and ACE2. Conclusion: Our study identifies the potential mechanisms of CLD on COVID-19 and beta-sitosterol, kaempferol, and stigmasterol may be the key compounds that exert antiviral effects against SARS-CoV-2.
This document discusses biomarkers in scleroderma and their potential uses. It defines biomarkers as measurable indicators of biological processes related to health and disease. Biomarkers could help predict disease progression and treatment response. The document reviews potential biomarkers related to skin involvement, lung fibrosis, renal disease, and pulmonary arterial hypertension in scleroderma. It highlights how biomarkers may help identify patients at high risk of organ complications who could benefit from early treatment or clinical trial enrollment.
This document provides a CV for Professor Gamal Mohamed Rabie Agmy, including his contact information, educational background, positions held, supervision of scientific theses, scientific researches, and scientific awards. He holds a Professor position of chest diseases and respiratory ICU at Assiut University Faculty of Medicine in Egypt. His CV outlines his educational qualifications including degrees in medicine, chest diseases, and lectureships and professorships. It also lists his supervision of 20 theses and over 70 scientific researches presented at various conferences. He has received several scientific awards for his research.
This document discusses the cardiovascular manifestations and effects of COVID-19. Some key points:
- Cardiovascular disease is a common comorbidity in patients with COVID-19, SARS, and MERS. Myocardial injury is independently associated with high mortality in COVID-19 patients.
- SARS-CoV-2 binds to ACE2 receptors, which are highly expressed in heart, blood vessels and other organs. This disrupts the balance between protective and deleterious RAAS pathways.
- COVID-19 can cause direct damage to heart through ACE2 downregulation and indirect damage from cytokine release/coagulopathy. This leads to complications like myocarditis, heart failure, arrhythmias and
This document discusses the management of sepsis and septic shock. It defines sepsis as a life-threatening organ dysfunction caused by infection and an acute change in the SOFA score of greater than 2 points due to infection. Septic shock is a subset of sepsis with circulatory and metabolic abnormalities increasing the risk of mortality. The management of sepsis involves early fluid resuscitation, administration of broad-spectrum antibiotics within 1 hour, and vasopressors for hypotension unresponsive to fluids.
Scleroderma Associated Lung Disease is presented by
Jane Dematte MD, MBA, Director, ILD program
Division of Pulmonary and Critical Care, Northwestern Feinberg School of Medicine
This document describes a case of fulminant myocarditis likely caused by COVID-19 infection in a 59-year-old woman. Key points:
- The patient presented with fever and chest pain but no respiratory symptoms. Tests confirmed SARS-CoV-2 infection and showed signs of cardiac injury.
- Echocardiograms showed myocardial thickening, edema, and dysfunction. She deteriorated into cardiogenic shock requiring interventions.
- Treatment for suspected acute myocarditis included immunoglobulins, steroids, and antivirals. Cardiac function improved but she required ongoing ECMO support for respiratory issues.
- This case suggests that in rare cases, COVID-19 can cause severe myocarditis
This document discusses anticoagulant use in COVID-19 patients. It notes that COVID-19 can cause a pro-coagulative state through endothelial dysfunction and cytokine storm, increasing thrombotic risk. Major guidelines recommend considering anticoagulants for hospitalized COVID-19 patients at high risk of thrombosis. For non-hospitalized patients, anticoagulants are not routinely recommended unless other indications exist. The document reviews evidence and recommendations on anticoagulant dosing, duration, and considerations in special populations.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high costs, morbidity, and mortality. They result in enormous healthcare expenditures and lost productivity. AECOPD episodes are also linked to accelerated long-term loss of lung function in continuous smokers. While symptoms may recover within a week, full recovery of health-related quality of life can take months. Noninvasive mechanical ventilation should be tried for patients with respiratory acidosis or increased work of breathing from AECOPD as it reduces intubation rates and improves health outcomes. Preventing and properly managing AECOPD is important for reducing its impacts.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
Prednisolone and Mycobacterium indicus pranii in Tuberculous Pericarditis (IMPI) was a randomized controlled trial that investigated whether adjunctive prednisolone or M. indicus pranii injections improved outcomes in 1,400 patients with tuberculous pericarditis, many of whom also had HIV. The trial found no significant difference in the primary outcome but prednisolone reduced the risk of constrictive pericarditis and hospitalization. However, prednisolone and M. indicus pranii both significantly increased the risk of cancer in these immunosuppressed patients.
Antibiotics for Acute Exacerbztions of COPD Ashraf ElAdawy
This document discusses the appropriate use of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD). It states that while steroids and bronchodilators are well-established treatments for exacerbations, there is ongoing debate around antibiotic use. Antibiotics are recommended for moderate to severe exacerbations with increased cough and sputum purulence as this indicates likely bacterial infection. Sputum culture alone should not determine antibiotic use, and severity factors like purulence, underlying lung function, age and comorbidities should guide treatment decisions. Antibiotics may reduce mortality and treatment failure when targeted at patients with bacterial exacerbations.
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptxNasir Sagar
High Blood pressure has multiple adverse reaction on different body system and its proper management causes beneficial effect in multiple co morbid condition.
Approach to young hypertensive patientsChandan Kumar
1. The document discusses hypertension in young adults, including definitions of different types of elevated blood pressure (e.g. hypertensive urgency, emergency), risk factors, clinical presentation, causes (primary vs. secondary), evaluation approach, and ambulatory blood pressure monitoring.
2. Most young adults with hypertension have primary/essential hypertension with no identifiable cause, though secondary hypertension can occur in about 10% of cases. Evaluation aims to confirm the diagnosis, assess cardiovascular risk, detect target organ damage, and identify secondary causes.
3. Ambulatory blood pressure monitoring provides blood pressure readings outside the office and can help identify white coat hypertension or masked hypertension, which have implications for risk stratification and treatment.
This study aimed to evaluate myocardial injury in children with unoperated congenital heart diseases using cardiac troponin I levels. The study found an 80% incidence of elevated cTnI levels in children with CHDs, indicating a high prevalence of myocardial injury. Univariate analysis revealed significant correlations between higher cTnI levels and hemodynamic factors like higher pulmonary to systemic blood flow and pressure ratios. The study concludes that cTnI is a useful marker for detecting myocardial injury in children with unoperated CHDs.
The SPRINT study compared an intensive blood pressure treatment target of less than 120 mm Hg to a standard target of less than 140 mm Hg in 9,361 patients at high risk for cardiovascular events but without diabetes. At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive group and 136.2 mm Hg in the standard group. After a median follow up of 3.26 years, the primary composite outcome of heart attack, acute coronary syndrome, stroke, heart failure or cardiovascular death occurred less frequently in the intensive group compared to the standard group. All-cause mortality was also lower in the intensive group, though rates of some adverse events were higher.
The learning speed of the feed forward neural
network takes a lot of time to be trained which is a major
drawback in their applications since the past decades. The
key reasons behind may be due to the slow gradient-based
learning algorithms which are extensively used to train the
neural networks or due to the parameters in the networks
which are tuned iteratively using some learning algorithms.
Thus, in order to eradicate the above pitfalls, a new learning
algorithm was proposed known as Extreme Learning Machines
(ELM). This algorithm tries to compute Hidden-layer-output
matrix that is made of randomly assigned input layer and
hidden layer weights and randomly assigned biases. Unlike the
other feedforward networks, ELM has the access of the whole
training dataset before going into the computation part. Here,
we have devised a new two-layer-feedforward network (TFFN)
for ELM in a new manner with randomly assigning the weights
and biases in both the hidden layers, which then calculates the
output-hidden layer weights using the Moore-Penrose generalized
inverse. TFFN doesn’t restricts the algorithm to fix the number
of hidden neurons that the algorithm should have. Rather it
searches the space which gives an optimized result in the neurons
combination in both the hidden layers. This algorithm provides a
good generalization capability than the parent Extreme Learning
Machines at an extremely fast learning speed. Here, we have
experimented the algorithm on various types of datasets and
various popular algorithm to find the performances and report
a comparison.
Total body sodium is the major determinant of extracellular
fluid volume. Increased total body sodium and fluid volume
is an inevitable consequence of end-stage renal failure
because kidneys have a key role in the regulation of sodium
balance
Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
Problem statement of Hypertension. Measurement of blood pressure. Recent diagnostic criteria and management guidelines. Prevention of Hypertension. National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular Diseases and Stroke
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
To study the variations of autonomic nervous system in hypertensive patients using a set of autonomic function tests
and to correlate cardiac autonomic function with Heart rate variability in hypertensives. Background: The pathophysiological mechanism for the development of hypertension is the lack of balance between sympathetic and parasympathetic nervous system. Both Heart rate variability (HRV) and Autonomic function tests provide a tool to know the concept of autonomic modulation of heart. They also forms an index of cardiac autonomic regulation. Methods: The study included 50 hypertensive patients and 50 normotensive
subjects. All the subjects underwent for the analysis of heart rate variability in time domain (TD) and frequency domain and a set of autonomic function tests were done to assess the autonomic functions. These results were compared with age and sex matched controls (normotensives). The subjects were selected based on exclusion-inclusion criteria. Results: Results showed that S: L ratio, Valsalva ratio & Heart rate response to deep breathing test values were decreased in Hypertensives as compared to Normotensives (p<0.05).><0.05). Both the time domain and frequency domain values of HRV reduced significantly in hypertensives indicated that there is increased sympathetic activity and decreased parasympathetic activity. Conclusion: From this study, it is evident that Hypertension can alter the normal autonomic functions of the body and predisposes to autonomic neuropathy. Early and regular screening of these individuals is necessary to prevent any future complications.
Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Objectives 1. To assess the prevalence of hypertension and its associated factors and 2. to estimate awareness, treatment, and adequacy of control of hypertension among study subjects. According to the Joint National Committee 7 JNC7 , normal blood pressure is a systolic BP 120 mmHg and diastolic BP 80 mm Hg. Hypertension is defined as systolic BP level of =140 mmHg and or diastolic BP level = 90 mmHg. A number of factors increase BP, including 1 obesity, 2 insulin resistance, 3 high alcohol intake, 4 high salt intake in salt sensitive patients , 5 aging and perhaps 6 sedentary lifestyle, 7 stress, 8 low potassium intake, and 9 low calcium intake. Shweta Pawar | Sujit Kakde | Ashok Bhosale "A Review: Hypertension" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42416.pdf Paper URL: https://www.ijtsrd.commedicine/other/42416/a-review-hypertension/shweta-pawar
Risk factors of Acute Coronary Syndrome at Prince Ali Bin Alhussein hospitalMinistry of Health
Objective:The aim of this survey to identify the relationship between ACS and its risk factors and the association between the risks factors themselves. Method: A retrospective study depends on the registered files of the admitted patients to Prince Ali Bin Alhussein hospital with ACS since April 2013 till October of 2013 included 174 patients. Result:The above mentioned data and results show a strong relationship between ACS and the mentioned risk factors. Conclusion: There is a strong relationship between risks factors themselves as D.M and hypertension, and between hypertension with the sex and smoking.There's an association between D.M and the patient's gender
This document provides an overview of hypertension including:
1. Defining hypertension as a blood pressure over 140/90 mmHg.
2. Describing the global epidemiology of hypertension, noting its highest prevalence in Sub-Saharan Africa at 40%.
3. Discussing the impact of hypertension as a leading cause of cardiovascular disease death worldwide, responsible for over 9 million deaths in 2010.
The Indian Consensus Document on Cardiac BiomarkerApollo Hospitals
Despite recent advances, the diagnosis and management of heart failure evades the clinicians. The etiology of congestive heart failure (CHF) in the Indian scenario comprises of coronary artery disease, diabetes mellitus and hypertension. With better insights into the pathophysiology of CHF, biomarkers have evolved rapidly and received diagnostic and prognostic value. In CHF biomarkers prove as measures of the extent of pathophysiological derangement; examples include biomarkers of myocyte necrosis, myocardial remodeling,
neurohormonal activation, etc.
This document summarizes hypertension, including its definition, classification, measurement, epidemiology, treatment and prevention. Hypertension is defined as high blood pressure and is classified based on blood pressure levels, identifiable causes, and organ damage. It is measured using a sphygmomanometer and affects over 1 billion people globally. Prevention involves population-wide and individual lifestyle changes to reduce risk factors and control blood pressure in diagnosed individuals.
This document provides an overview of hypertension (high blood pressure). It defines hypertension and normal blood pressure readings. It discusses factors that influence blood pressure like heart rate, vascular resistance, and fluid volume. It covers the etiology, epidemiology, types (essential, secondary, malignant, isolated systolic, resistant), signs and symptoms, and pathophysiology involving the sympathetic nervous system, renin-angiotensin system, and fluid volume regulation. It also addresses the diagnosis, complications, and management of hypertension through both non-pharmacological (lifestyle modifications, diet) and pharmacological (ACE inhibitors, ARBs, diuretics, calcium channel blockers, beta blockers) approaches.
PREVENTION OF HEART PROBLEM USING ARTIFICIAL INTELLIGENCEijaia
This document discusses building a machine learning model to predict the probability of patients experiencing heart problems based on their medical data. It analyzes data from 1000 patients across India on risk factors like family history, smoking, hypertension, cholesterol levels, blood sugar, obesity, lifestyle, previous bypass surgery, and iron levels. The model aims to help doctors make treatment decisions and minimize false negatives, where the model predicts no problem when one exists. It finds certain risk factors like family history, age over 50, and being male are correlated with higher heart problem rates. The model will be trained on this data to predict new patients' heart problem probability.
Similar to Perspective of Cardiac Troponin and Membrane Potential in People Living with Hypertension (20)
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has been used as a treatment for infectious diseases for over a century. It involves transfusing plasma from patients who have recovered from an infection into patients who are currently ill with that same infection. Clinical trials are now investigating its use for COVID-19. While some early studies showed promising results, larger randomized controlled trials found no significant benefit of convalescent plasma for severe COVID-19. Further research is still needed to determine whether certain patient populations or plasma dosages may be more effective.
The Negative Clinical Consequences Due to the Lack of the Elaboration of a Sc...asclepiuspdfs
Until a few years ago, the immune system was considered as responsible for the only defense against microbial infections and other external agents. On the contrary, the immune cells have been proven to be linked not only through cell-cell contact but also by releasing proteins capable of influencing the immune-inflammatory response, the so-called cytokines or interleukins. Moreover, the cytokines have appeared to play not only immune activities but also metabolic and systemic effects influencing the overall biological systems, including the nervous, the endocrine, and the cardiovascular systems, by representing the main endogenous molecules responsible for the maintenance of the unity of the biological life. Therefore, only the systematic clinical consideration of cytokine effects may allow the generation of real future holistic medicine.
The great benefit of blood/blood constitutes therapy is the ability to provide transfusion support for patients with many unique hematologic conditions. For some patients, such as patients with sickle cell disease, thalassemia major, immune hemolytic anemia, anemia of kidney disease, and aplastic anemia may need for this consolidation extends throughout their life. By knowing the alteration mechanisms of these conditions, we can appreciate the stationary, urgency, and the value of the transfused red blood cell (RBC).
Decreasing or Increasing Role of Autologous Stem Cell Transplantation in Mult...asclepiuspdfs
During the past four decades, autologous stem cell transplantation (ASCT) has been the first choice and the standard option for the treatment of newly diagnosed patients with multiple myeloma. The introduction of new agents such as thalidomide, lenalidomide, and bortezomib has led to a clear improvement in basic approach and those agents became the standard of care in the induction phase; however, they were not able to play the role of ASCT in term of progression-free survival and overall survival. Debate continues about the best induction, consolidation, and maintenance taking into account the toxicities of these new agents. The new monoclonal antibody (anti CD38) starts to take its place in the induction setting and it seems to be a promising agent in the high-risk group. Until recently, ASCT is the standard treatment for newly diagnosed patients.
Comparison of the Hypocalcemic Effects of Erythropoietin and U-74389Gasclepiuspdfs
Aim: This study calculated the effects on serum calcium (Ca) levels, after treatment with either of two drugs: The erythropoietin (Epo) and the antioxidant lazaroid (L) drug U-74389G. The calculation was based on the results of two preliminary studies, each one of which estimated the certain influence, after the respective drug usage in an induced ischemia-reperfusion animal experiment. Materials and Methods: The two main experimental endpoints at which the serum Ca levels were evaluated were the 60th reperfusion min (for the Groups A, C, and E) and the 120th reperfusion min (for the Groups B, D, and F). Especially, the Groups A and B were processed without drugs, Groups C and D after Epo administration, whereas Groups E and F after the L administration. Results: The first preliminary study of Epo presented a non-significant hypocalcemic effect by 0.34% ± 0.68% (P = 0.6095). However, the second preliminary study of U-74389G presented a non-significant hypercalcemic effect by 0.14% ± 0.66% (P = 0.8245). These two studies were coevaluated since they came from the same experimental setting. The outcome of the coevaluation was that L is 2.3623042-fold (2.3482723–2.3764196) more hypercalcemic than Epo (P = 0.0000). Conclusions: The antioxidant capacities of U-74389G ascribe 2.3623042-fold more hypercalcemic effects than Epo (P = 0.0000).
The term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia.
Management of Immunogenic Heparin-induced Thrombocytopeniaasclepiuspdfs
Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, due to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improve clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-Vitamin K antagonist oral anticoagulants.
A 73-year-old woman presented with fever and linearly arranged erythema on her chest, back, and abdomen. She was initially diagnosed with drug-related scratch dermatitis due to antibiotic use. However, her fever persisted and lab work showed abnormal liver enzymes and very high ferritin levels. Biopsies ruled out infection and malignancy. She was ultimately diagnosed with adult Still's disease (ASD) based on her symptoms and lab results. Treatment with prednisolone resolved her symptoms within a week. This case demonstrates that ASD can present with various skin lesions, and a high index of suspicion is needed for diagnosis.
Bone Marrow Histology is a Pathognomonic Clue to Each of the JAK2V617F, MPL,5...asclepiuspdfs
According to the World Health Organization and Clinical Laboratory Molecular and Pathological criteria bone marrow pathology in JAK2V617F mutated trilinear myeloproliferative neoplasm (MPN) patients essential thrombocythemia (ET) and polycythemia vera are indistinguishably featured by clustered medium to large pleomorphic megakaryocytes and increased cellularity (60–90%) due to increased erythropoiesis and megakaryopoiesis. MPL515 mutated ET is the second distinct clonal MPN characterized by thrombocythemia in a normocellular bone marrow showing clustered increased large to giant mature megakaryocytes with staghorn-like hyperlobulated nuclei. Calreticulin (CALR) mutated hypercellular thrombocythemia associated with prefibrotic megakaryocytic, granulocytic myeloproliferation (MGM) recently became the third distinct MPN featured by dense clusters of immature megakaryocytes with cloud-like nuclei. Bone marrow pathology in newly diagnosed MPN patients appears to be a pathognomonic clue for diagnostic differentiation between JAK2V617F mutated trilinear MPN, MPL515 normocellular thrombocythemia, and CALR thrombocythemia with MGM characteristics followed by secondary reticulin fibrosis. Their natural histories clearly differ featured by an increase of erythro/granulopoiesis and cellularity in JAK2V617F, decrease of erythropoiesis and cellularity in MPL515 and increase of dual megakaryo/granulopoiesis and cellularity in CALR mutated MPN.
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
Lymphoma of the Tonsil in a Developing Communityasclepiuspdfs
The lymphoma of the tonsil is a rarity. Single case reports have appeared in countries as disparate as China, Greece, India, Japan, and Turkey. Therefore, this paper presents cases found in Nigeria among the Ibo ethnic group. The epidemiological comparisons are deemed to be worthy of documentation such as age ranges and sides of involvement.
Should Metformin Be Continued after Hospital Admission in Patients with Coron...asclepiuspdfs
Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
Clinical Significance of Hypocalcemia in COVID-19asclepiuspdfs
- Several retrospective studies found that hypocalcemia is common in hospitalized patients with COVID-19, occurring in 62-78% of patients.
- Hypocalcemia is associated with more severe disease and worse outcomes, including increased risk of hospitalization, longer hospital stays, multi-organ failure, acute respiratory distress syndrome, and death.
- The cause of hypocalcemia in COVID-19 patients is unclear but may involve consumption of calcium for viral entry into cells or reflect severity of illness. Further study is needed.
Excess of Maternal Transmission of Type 2 Diabetes: Is there a Role of Bioche...asclepiuspdfs
Objective: An excess of maternal transmission of Type 2 diabetes (T2D) has been reported in some populations but not confirmed in other studies. Mitochondrial inheritance has been proposed to explain such excess. In the present paper, we have considered the presence of T2D in the mother and/or in the father in relation to the risk of T2D and to age at onset of the disease in the offspring. The distribution of two genetic polymorphisms involved in glucose metabolism in relation to the presence of T2D in the mother has been also considered. Materials and Methods: Two hundred and seventy-nine participants with T2D were studied in the population of Penne, a small rural town in the eastern side of central Italy. Adenosine deaminase locus 1 (ADA1) and phosphoglucomutase locus 1 (PGM1) phenotypes were determined by starch gel electrophoresis. Statistical analyses were carried out using commercial software (SPSS). Results: The proportion of patients from T2D mothers is much greater as compared to the proportion of the patients from T2D fathers (P < 0.0001). Age at onset of the disease in patients in whom one or both parents are T2D is lower as compared to other patients. The distribution of ADA1 and PGM1 phenotypes in participants with T2D depends on the presence of diabetes in the mother. Conclusions: About the transmission of T2D, our data confirm the high proportion of maternal T2D and show the role of two common biochemical polymorphisms involved in glucose metabolism.
The Effect of Demographic Data and Hemoglobin A 1c on Treatment Outcomes in P...asclepiuspdfs
Objective: Diabetes mellitus, the most common cause of non-traumatic foot amputations, is a life-threatening condition due to its high mortality and morbidity. In our study, we retrospectively evaluated our patients with diabetic foot syndrome in our clinic. Materials and Methods: The demographic data, duration of diabetes, Wagner classification, haemoglobin A 1c (HbA1c) levels, white blood cell, C-reactive protein sedimentation levels, hospital stay, and treatment results were evaluated retrospectively in 14 patients with diabetic foot between January 2017 and December 2018. Results: The mean age of the patients was 62.43 ± 7.7 years. Of the 14 patients, 3 were females and 11 were males. All 14 patients were type 2 diabetes mellitus. When diabetic foot Wagner classification was performed, 6 patients were evaluated as Wagner 2, five patients were Wagner 3, and three patients were evaluated as Wagner 4. Nine patients had complete amputation and 3 had vascular surgery. Conclusion: Although the level of HbA1c is below the target level, the risk of diabetic foot is increased when there is no adequate diabetes mellitus foot training. Inadequate diabetic patient education and hospitalization of patients after infection progress the amputation rate.
Self-efficacy Impact Adherence in Diabetes Mellitusasclepiuspdfs
The aim of the paper is to explore how self-efficacy (SE) is associated with adherence among adults with diabetes mellitus (DM). Methods: The search of electronic databases identified 564 records from 2007 to 2017 on SE and adherence from different perspectives and its effect on adults with DM. Discussions: SE increases the confidence in adults in their self-care behaviors. Non-adherence continues to be a significant barrier to SE. SE and adherence should be informed by an understanding of theoretical frameworks and the individual characteristics. Conclusion: Adherence is likely among adults with better SE to empower them to make valid decisions about their health. Interventions to improve SE should be tailored based on different types of non-adherence such as intentional and unintentional non-adherence. Implications: An intercollaborative professional practice approach is crucial to improve SE and adherence for sound judgment and valid decision-making.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Management Of Hypoglycemia In Patients With Type 2 Diabetesasclepiuspdfs
Hypoglycemia is the rate-limiting step of intensive management in patients with diabetes. Lowering one’s A1C to a prescribed target is expected to mitigate one’s risk of developing long- and short-term diabetes-related complications. Several of the less expensive and commonly prescribed glucose lowering agents favored by practitioners result in weight gain, hypoglycemia, and even an increased risk of cardiovascular (CV) mortality. Although achieving a targeted A1C of <7 % is the standard of care, clinicians often fail to evaluate patients for glycemic variability which can increase oxidative stress driving long-term diabetes-related complications including CV death. The use of concentrated insulins and glucagon-like peptide-1 receptor agonists separately or in combination with each other reduces glycemic variability and one’s risk of hypoglycemia. Pharmaceutical agents which allow patients to safely achieve their targeted A1C without weight gain and hypoglycemia should be preferred in patients with type 2 diabetes.
Predictive and Preventive Care: Metabolic Diseasesasclepiuspdfs
South Asians have a very high incidence of ischemic heart disease and stroke. In addition, they also have a very high incidence of metabolic diseases such as prehypertension, hypertension, visceral obesity, metabolic syndrome, prediabetes, type-2 diabetes, and its clinical complications. Currently, there are over 75 million diabetic subjects in India and an equal number of prediabetics. Republic of China has taken over India as the diabetes capital of the world, with over 115 million diabetics. Modern medicine is disease focused and has failed to address the prevention of these chronic diseases. According to the reports from the United Nations (Millennium Development Goals [MDGs], the World Health Organization, Global Health Initiatives, and the non-communicable disease risk task force), obesity has increased by 2-fold and type-2 diabetes by 4-fold worldwide. Experts in this field predict that chances of meeting the MDGs set by the UN members of reducing the incidence of these diseases at 2025 to the level of 2020 are very little. Western medicine has failed to reduce or reverse the trend in the incidence of these diseases. We feel that an integrated approach to health care may be a better option, to reduce the disease burden in developing and resource-poor countries. Having said that, one cannot prevent something that one is not aware of, as such it is the need of the hour for us, to develop a robust predictive and preventive health-care platform. In an earlier article, we presented our views on reducing or reversing cardiometabolic diseases. There is great enthusiasm among the health-care providers and professional bodies that integration of emerging technologies will help develop personalized, precision medicine, as well as reduce the cost of health-care worldwide.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Nnodim, et al.: Cardiac troponin and membrane potential: Hypertension
Asclepius Medical Case Reports • Vol 3 • Issue 2 • 2020
high in fat and cholesterol jack up the hypertensive risk. It
can increase as a result of genetic inheritance.[5]
Symptoms of hypertension vary depending on the severity
of the situation and progression of the disease. There may
be no symptoms or symptoms linked with hypertension.
They include: Chest pain (angina), tightness or pressure in
the chest, shortness of breath, fatigue, pain in the neck, back,
arms, or shoulders, persistent cough, loss of appetite, and leg
or ankle swelling.[6]
Hypertension seems to affect the status of cardiac troponin
and membrane potential. Troponin is a form of protein
that resides in the muscles of the heart. Troponin normally
is not seen in the blood. However, when heart muscles
are injured, troponin goes into the bloodstream. As heart
injures, elevation at greater amounts of troponin is released
in the blood.[7]
On the other hand, membrane potential is due to difference
in concentration and permeability of important ions across
a membrane. Due to unequal concentrations of ions across
a membrane, the membrane has an electrical charge.[8]
Membrane potential simply is the difference between the
electric potential in the inside and outside matrices of the cell
when it is not excited.[9]
Every cell of the body possess its
own membrane potential, but only excitable cells – nerves
and muscles – are capable to change it and generate an action
potential.[10]
In the light of the above, it will be very necessary to
determine cardiac troponin and membrane potential in
hypertension to provide information for better diagnosis
and management.
MATERIALS AND METHODS
Subjects
A total of 120 subjects between the ages 30 and 70 years were
recruited for this study. Sixty were hypertensive subjects
who had been attending cardiology clinic for not 3 months
diagnosed of hypertension consisting of 30 males and 30
females. Sixty were apparently healthy individuals who
served as controls subjects of the same age limits and sex
who had no record of any other ailment.
Blood collection
Venous blood samples (5 ml) were collected aseptically by
venipuncture from each of the subjects using a 5 ml sterile
disposable syringe and needle. The whole blood samples were
dispensed into a pre-labeled plain dry specimen container and
allowed to clot. The clotted samples were centrifuged at 3000
rpm for 5 min to separate and obtain the serum for analysis.
Informed consent of the participants was obtained and was
conducted in line with the ethical approval of the hospital.
Biochemical assay
The serum cardiac troponin 1 was determined by enzyme-
linked immunosorbent assay technique[11]
while membrane
potential was determined by Nernst Equation.[12]
Statistical analysis
The results were expressed as mean ± standard deviation
(SD). The statistical evaluation of data was performed using
independent students.
RESULTS
The result in Table 1 revealed that the levels of cardiac troponin
1 in hypertension were significantly increased when compared
with control subjects while the levels of membrane potential
were significantly decreased when compared to control at P
0.05.However, there is no significant difference in the levels
of cardiac troponin 1 and membrane potential in Table 2.
DISCUSSION
Hypertension is a major health disorder throughout the
world as a result of its high prevalence and its association
with increased risk of cardiovascular disease. Advances in
the diagnosis and treatment of hypertension have played a
relevant role in recent dramatic declines in coronary heart
disease and stroke mortality in industrialized countries.[13]
Hypertension is dangerous because the heart works harder
to move blood through the blood vessels. HBP contributes to
the hardening of the arteries, decrease of blood and oxygen
flow to the heart. When left untreated, HBP can lead to heart
attack, heart failure, stroke, erectile dysfunction, kidney
failure, and irregular heartbeat.[14]
The result from this study showed that the serum cardiac
troponin 1 in hypertension was significantly increased when
compared with the controls. This elevation of troponin in
hypertension could be linked to the necrosis of cardiac
muscles as a result of cardiac myopathies.[15]
This leads
to spillage of troponin into the blood stream. Similarly, it
could be associated with associated with microvascular
and macrovascular complications as this causes myocardial
injury.[16]
This is in line with the work of Eggers et al.,[17]
in
which there an elevation of troponin in coronary disease.
Table 1: Mean±SD values of serum cardiac troponin
1 and membrane potential in hypertensive subjects
Parameters Hypertensive
(n=30)
Controls
Subjects
(n=30)
Troponin 1 (µg/ml) 0.083±0.01* 0.02±0.01
Membrane potential(J) 145.64±12.27* 262.74±13.42
*Statistically significant compared with control (P 0.05);
SD: Standard deviation
3. Nnodim, et al.: Cardiac troponin and membrane potential: Hypertension
Asclepius Medical Case Reports • Vol 3 • Issue 2 • 2020 6
In the same vein, the increase in cardiac troponin 1 in
hypertension could be associated with ion transport disorder.
In which there are production of circulating Na+ transport
inhibitors that act on renal epithelial cells and vascular smooth
muscle cells.[18]
This results to the idea that, in response to
salt loading, the kidney produces a circulating substance that
causes both natriuresis and vasoconstriction. The increased
intracellular Na+, acting on a plasma membrane Na+-Ca2+
exchange system, would result to increased intracellular Ca2+.
Increased vascular smooth muscle cell Ca2+, by its well-
known action on the contractile machinery, would in turn lead
to contraction of vascular smooth muscle cells or increased
responsiveness to vasoconstrictors.[19]
Increased vascular tone
would raise BP, contributing to the desired natriuresis. This
is in agreement with the report of Eggers et al.,[17]
in which
increase in cardiac troponin activate the development of
hypertension.These substances may not have been appreciated
in the past because of their failure to circulate significantly.An
excel-lent example of this is the endothelium-derived relaxing
factor. This agent, whose chemical identity is probably nitric
oxide, 81 is released from endothelial cells in response to a
various hormonal and physical factors.[20]
Furthermore, hypertension remains the number one silent
killer in this generation, claiming thousands of lives all over
the world. The level of membrane potential was significantly
decreased in hypertension when compared with the control.
This could be linked to sodium potassium pump dysfunction,
in which the ion transport is highly hindered. This tends to
affect the microvascularity of the cell in hypertension. Hence,
it affects the contractibility of the diastolic and systolic system
of the body. This is in line with the work of Ashcroft and
Rorsman,[21]
in which the membrane potential was adversely
affected in diabetes. The defects in the transport systems
play an important role in the pathogenesis of hypertension
due to the cellular handling of Na+ and Ca2+ions in vascular
smooth muscle cells. Na+ pump inhibitors would also be
expected to affect vascular smooth muscle function. In these
cells, the inhibitors would cause cell Na+ and volume to
rise and membrane potential to fall.[22]
However, when the
Na+ intake is matched by Na+ excretion at a plasma volume
and BP very close to normal, there may not be alteration
in the membrane potential, and the vascular architecture is
intact.[23]
However, in hypertensive individual, there is failure
to excrete the Na+ load at an adequate rate; hence, there is
volume overloaded, which will continuously produce the
natriuretic or hypertensive substance which interfere with
the integrity of the membrane potential.[24]
The membrane
potential is the main area of cellular function and cell-to-cell
signaling, and ultimately body functions.[25]
CONCLUSION
The increase in cardiac troponin and decrease in membrane
potential may probably indicate errors, defects or abnormality
in the ion transport system in hypertension.
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How to cite this article: Nnodim JK, Chinedu-Madu JU,
Nwaokoro JC, Bede-Ojimadu OO, Bako H. Perspective
of Cardiac Troponin and Membrane Potential in People
Living with Hypertension. Asclepius Med Case Rep
2020;3(2):4-7.