Category: Nevin Manimala

Arq Bras Cardiol. 2022 Jul;119(1):87-94. doi: 10.36660/abc.20210477.

ABSTRACT

BACKGROUND: Catheter ablation is a well-established therapy for rhythm control in patients who are refractory or intolerant to anti-arrhythmic drugs (AAD). Less is known about the efficacy of catheter ablation compared with AAD as a first-line strategy for rhythm control in atrial fibrillation (AF).

OBJECTIVES: We aimed to perform a systematic review and meta-analysis of catheter ablation vs. AAD in patients naïve to prior rhythm control therapies.

METHODS: PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials that compared catheter ablation to AAD for initial rhythm control in symptomatic AF and reported the outcomes of (1) recurrent atrial tachyarrhythmias (ATs); (2) symptomatic AF; (3) hospitalizations; and (4) symptomatic bradycardia. Heterogeneity was examined with I2statistics. P values of < 0.05 were considered statistically significant.

RESULTS: We included five trials with 994 patients, of whom 502 (50.5%) underwent catheter ablation. Mean follow-up ranged from one to five years. Recurrences of AT (OR 0.36; 95% CI 0.25-0.52; p<0.001) and symptomatic AF (OR 0.32; 95% CI 0.18-0.57; p<0.001), and hospitalizations (OR 0.25; 95% CI 0.15-0.42; p<0.001) were significantly less frequent in patients treated with catheter ablation compared with AAD. Symptomatic bradycardia was not significantly different between groups (OR 0.55; 95% CI 0.18-1.65; p=0.28). Significant pericardial effusions or tamponade occurred in eight of 464 (1.7%) patients in the catheter ablation group.

CONCLUSION: These findings suggest that catheter ablation has superior efficacy to AAD as an initial rhythm control strategy in patients with symptomatic AF.

PMID:35830118 | DOI:10.36660/abc.20210477

Arq Bras Cardiol. 2022 Jul;119(1):14-22. doi: 10.36660/abc.20210412.

ABSTRACT

BACKGROUND: The systemic immune-inflammation index (SII) has been reported as a new prognostic marker in tumors and cardiovascular diseases.

OBJECTIVE: To investigate the association of SII with adverse cardiovascular events in patients with ST-segment elevated myocardial infarction (STEMI).

METHODS: A retrospective observational study was conducted on 843 patients with STEMI. Patients were divided into two groups based on the median value of SII. Major adverse cardiovascular events were compared between SII groups. Cox regression analysis was used for detecting independent predictors of cardiovascular adverse events. The improvement of discrimination ability by adding SII to the traditional risk factors such as age, hypertension, diabetes mellitus, and male gender for major adverse events was calculated by c-statistics, integrated discrimination improvement, and net reclassification improvement. A two-sided p-value <0.05 was considered significant.

RESULTS: High SII group was older than the low SII group (61.2±11.2, 59.2±7.9, respectively, p=0.002). The high SII group had higher rates of cardiac death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, revascularization, and composite major adverse cardiovascular events than the low SII group. SII was an independent predictor of all events mentioned above. Adding SII to traditional risk factors improved their discrimination ability for cardiovascular events. SII was superior to the neutrophil-to-lymphocyte and platelet-to- lymphocyte ratios for predicting cardiovascular adverse events.

CONCLUSION: SII was an independent predictor of major adverse events in patients with STEMI and may be used to improve the prediction of adverse events, especially when combined with traditional risk factors.

PMID:35830117 | DOI:10.36660/abc.20210412

Arq Bras Cardiol. 2022 Jul;119(1):97-106. doi: 10.36660/abc.20210530.

ABSTRACT

BACKGROUND: There is limited data on the prognostic value of stress cardiac magnetic resonance (CMR) in older adults.

OBJECTIVE: To determine the prognostic value of adenosine stress CMR in older individuals with known or suspected coronary artery disease (CAD).

METHODS: Between 2010 and 2015, consecutive patients aged 65 years or older referred for adenosine stress CMR were followed for the occurrence of severe cardiac events (cardiac death and nonfatal myocardial infarction) and major adverse cardiovascular events (MACE) that also included hospitalization for heart failure and ischemic stroke. Univariate and multivariate analyses were performed to determine the prognostic value of myocardial ischemia, with p-value <0.05 considered statistically significant.

RESULTS: After a mean follow-up period of 50.4 months in 324 patients (48% male, 73±7 years), 21 severe cardiac events and 52 MACE occurred. Patients with myocardial ischemia (n=99) had significantly higher rates of severe cardiac events (HR 5.25 [95% CI 2.11-13.04], p<0.001) and MACE (HR 3.01 [95% CI 1.75-5.20], p<0.001) than those without ischemia. Multivariable analysis determined ischemia as an independent predictor of severe cardiac events (HR 3.14 [95% CI 1.22-8.07], p=0.02) and MACE (HR 1.91 [95%CI 1.02-3.59], p=0.04). Ischemia provided an incremental prognostic value over clinical factors and left ventricular ejection fraction for predicting severe cardiac events and MACE (p<0.01 for both). No severe adverse events occurred during or immediately after CMR examinations.

CONCLUSION: Adenosine stress CMR is safe and has prognostic value in older adults with known or suspected CAD.

PMID:35830106 | DOI:10.36660/abc.20210530

Arq Bras Cardiol. 2022 Jul;119(1):25-34. doi: 10.36660/abc.20210521.

ABSTRACT

BACKGROUND: Patient unawareness about acute myocardial infarction, its complications and the benefits of early revascularization is a crucial point that determines the outcomes. Moreover, the relationship between socioeconomic factors and patient presentation to primary percutaneous coronary intervention (PPCI) has not been fully studied.

OBJECTIVES: Our objective was to investigate whether or not patient unawareness and other socioeconomic factors impact patient presentation to PPCI.

METHODS: The study comprised 570 patients with ST-segment elevation myocardial infarction (STEMI) revascularized by PPCI. The patients were classified into two groups according to the total ischemia time (the time from STEMI symptom onset to balloon dilatation); group I: Patients with early presentation (1-12 hours). Group II: Patients with late presentation (>12-24 hours). Socioeconomic factors, clinical outcomes including mortality and major adverse cardiac events (MACE) were evaluated in each group. A p-value < 0.05 was considered statistically significant.

RESULTS: There are different socioeconomic factors affecting patient presentation to PPCI. Multivariate regression analysis identified the independent socioeconomic predictors as following: low educational level – OR 4.357 (CI95% 1.087-17.47, p=0.038), social isolation – OR 4.390 (CI95% 1.158-16.64, p=0.030) and unawareness about the benefits of early revascularization – OR 4.396 (CI95% 1.652-11.69, p=0.003). Mortality and MACE were higher in group II.

CONCLUSION: Patient unawareness and low socioeconomic status were associated with late presentation to PPCI with more adverse outcomes.

PMID:35830099 | DOI:10.36660/abc.20210521

Arq Bras Cardiol. 2022 Jul 11:S0066-782X2022005010204. doi: 10.36660/abc.20210938. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 has placed a tremendous burden on physicians worldwide, especially women physicians, affected by increased workload and loss of quality of life.

OBJECTIVE: To assess the effects of the COVID-19 pandemic on the quality of life, burnout and spirituality of Brazilian women physicians directly or indirectly providing care to COVID-19 patients.

METHODS: Prospective, observational study performed from July 28 to September 27, 2020, in Brazil, with women physicians from 47 specialities, the most frequent being cardiology (22.8%), with no age restriction. They voluntarily answered an online survey with questions on demographic and socioeconomic characteristics, quality of life (WHOQOL-brief), spirituality (WHOQOL-SRPB), and statements from the Oldenburg Burnout Inventory. Statistical analysis used the R software, beta regression, classification trees, and polychoric correlation matrix, with a 5% of significance level.

RESULTS: Of the 769 respondents, 61.6% reported signs of burnout. About 64% reported wage loss of up to 50% during the pandemic. Some reported lack of energy for daily tasks, frequent negative feelings, dissatisfaction with capability for work, and caring for others not adding meaning to their lives. Negative feelings correlated negatively with satisfaction with sexual life and personal relations, and energy for daily tasks. The inability to remain optimistic in times of uncertainty correlated positively with feeling unsafe daily and not acknowledging that caring for others brings meaning to life.

CONCLUSION: This study showed a high frequency of burnout among Brazilian women physicians who answered the survey during the COVID-19 pandemic. Nevertheless, they presented with a relatively good quality of life and believed that spirituality comforted and reassured them in hard times.

PMID:35830077 | DOI:10.36660/abc.20210938

Expert Rev Respir Med. 2022 Jul 13. doi: 10.1080/17476348.2022.2100351. Online ahead of print.

ABSTRACT

BACKGROUND: : The tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and its receptor, death receptor 5 (DR5), participate in pulmonary cell apoptosis. This study aimed to investigate the clinical value of soluble DR5 and TRAIL for prognosis assessment in acute respiratory distress syndrome (ARDS).

RESEARCH DESIGN AND METHODS: : Serum and bronchoalveolar lavage fluid (BALF) samples were collected from ARDS patients and controls. Patients were followed-up until death or discharge. Soluble DR5, TRAIL, TNF-α, soluble receptor for advanced glycation end-products (sRAGE), and albumin levels were measured using the Magnetic Luminex or enzyme-linked immunosorbent assays. Data were analyzed according to their distribution and statistical purpose.

RESULTS: : Serum and BALF DR5 levels were elevated in patients with ARDS; TRAIL elevation and reduction was observed in BALF and serum, respectively. Serum DR5 was higher in non-survivors compared to survivors. Serum DR5 was positively correlated with serum TNF-α and critical illness scores and negatively correlated with serum TRAIL. Serum and BALF DR5 was positively correlated with the alveolar epithelial cell damage (sRAGE) and lung fluid leakage indicators. Serum DR5 exhibited potential for predicting mortality in patients with ARDS.

CONCLUSIONS: : Serum soluble DR5 elevation, a valuable prognosis predictor in ARDS, may be associated with alveolar epithelial cell apoptosis.

PMID:35822538 | DOI:10.1080/17476348.2022.2100351

Faraday Discuss. 2022 Jul 13. doi: 10.1039/d2fd00045h. Online ahead of print.

ABSTRACT

Gas phase ion-molecule reactions are central to chemical processes across many environments. A feature of many of these reactions is an inverse relationship between temperature and reaction rate arising from a submerged barrier (an early reaction barrier that is below the energy of the separated reactants), which often arises due to a stable pre-reactive complex. While the thermodynamics and kinetics of many ion-molecule reactions have been extensively modelled, the reaction kinetics of ion-molecule reactions involving radical ions are less explored. In this investigation, the target reactions involve distonic radical ions, where the charge and radical moieties are separated within the molecular structure. Experimental rate coefficients for the reaction of either C₂H₂ or C₂H₄ with a suite of eighteen distonic radical ions are reported. Rate coefficients are modelled using potential energy schemes combined with a statistical reaction-rate (RRKM-ME) model. Second-order rate coefficients are in good agreement with experimental values with an average RMS deviation of 37% across three orders of magnitude. These predictions are generally sensitive to the relative energetics of the pre-reactive complex forward transition state but are relatively insensitive to the overall exothermicity of the covalent-addition product.

PMID:35822523 | DOI:10.1039/d2fd00045h

J Genet Psychol. 2022 Jul 13:1-14. doi: 10.1080/00221325.2022.2098003. Online ahead of print.

ABSTRACT

This study provides the first empirical account of mental health issues among sexual minority adolescents in Greece and the effects on mental health of both bullying and victimization in relation to adolescents’ sexual orientation. A sample of 757 adolescents (M age = 15.98, SD = 0.84) completed self-reported scales measuring school bullying victimization experiences, levels of depression, feelings of loneliness, hopelessness, feeling of belonging in school, self-esteem, and sense of wellbeing. Statistically significant differences were observed between heterosexuals and gay adolescents in depression, loneliness, bullying behavior and school belongingness. Gay adolescents are more likely to present higher levels of depression. Furthermore, sexual orientation was also found to be significant moderator of the effect of bullying victimization on loneliness. Bullying was associated with low sense of school belonging and victimization with depressive symptomatology, loneliness and low sense of school belonging and self-esteem. Students’ self-esteem and school belongingness were found to have a protective role against loneliness, depression and hopelessness. The findings of the current study provide valuable information to school psychologists, teachers, policy makers, and other professionals whose goals are to enhance adolescent functioning and adaptation. It is suggested that intervention strategies designed to promote resilience should incorporate sexual orientation issues.

PMID:35822499 | DOI:10.1080/00221325.2022.2098003

Indian Pediatr. 2022 Jul 12:S097475591600441. Online ahead of print.

ABSTRACT

BACKGROUND: Wasting and stunting commonly coexist, supposedly due to biological and social mechanisms. In under-five children, low-ponderosity is defined as <-2SD of WHO standards for either weight for height (wasted) or body mass index-for-age (thin) metrics. Unlike body mass index-for-age, weight for height ignores physiological changes in ponderosity with age, resulting in overestimation of wasting in comparison to thin-ness in under-5 populations with high stunting prevalence. This suggests a plausible statistical explanation for the wasting-stunting association.

AIM: To test the null hypothesis that wasting-stunting (WaSt) and thinness-stunting (ThSt) associations are similar.

METHODS: Demographic Health Survey datasets (2010-2020) from South and South-East Asia (7 countries) and Sub-Saharan Africa (13 countries) were evaluated. WaSt and ThSt associations were estimated as odds ratio (OR) for individual datasets, which was pooled (random-effects meta-analysis). Stratified analyses were done for sex, age and region.

RESULTS: Young infants (0-6 months) comprised 8-14% of under-five children, with equal representation of boys and girls. Participants, especially Asians, were mostly shorter with lower ponderosity than WHO stand-ards. WaSt prevalence was higher than ThSt in the 6-59 months age group, but lower in young infants. Pooled WaSt estimates were not significant: Asia (OR 0.95; 95% CI 0.75-1.14), Africa (1.17; 0.95-1.40), and combined (1.09; 0.93-1.24). In contrast, pooled ThSt associations were significantly negative: Asia (0.63; 0.50-0.76), Af-rica (0.82; 0.68-0.96), and combined (0.75; 0.65-0.85). In girls, these associations were attenuated for WaSt (0.96; 0.8-1.1), but enhanced for ThSt (0.6; 0.5-0.7).

CONCLUSION: WaSt and ThSt associations are dissimilar. This suggests a primary statistical explanation for the reported wasting-stunting association, originating from ignoring physiological changes with age.

PMID:35822490

Turk Arch Pediatr. 2022 Jul;57(4):459-466. doi: 10.5152/TurkArchPediatr.2022.21359.

ABSTRACT

OBJECTIVE: In recent years, young children from all socioeconomic conditions found an oppor- tunity to own or access video game devices. The precisely defined effects of video gaming on young children’s behaviors and mental health are unknown. This study aimed to investigate the relationship between the psychosocial well-being and video gaming in preschool children.

MATERIALS AND METHODS: The video gamer (n = 70) and non-gamer (n = 140) children between 2 and 6 years old and their mothers were included in the study. Psychosocial well-being was assessed using the Strengths and Difficulties Questionnaire parent version. Multivariable logis- tic regressions were used.

RESULTS: 30% of the video gamers played video games for more than 1 hour per day. Factors associated with video gaming included sex, birth order, age of first screen exposure, daily screen time, and parent(s) video gaming. Being a boy, having a daily screen time of more than 1 hour and parent(s) video gaming increased the probability of video gaming [Odds (95% CI) = 3.00 (1.42-6.31), P = .004; 6.28 (2.86-13.80), P < .001; 6.49 (2.77-15.23), P < .001, respec- tively]. Not being the first child and having an age of first screen exposure older than 12 months old decreased the probability of video gaming [Odds (95% CI) = 0.29 (0.11-0.76), P = .012; 0.34 (0.13-0.89), P = .027, respectively]. Video gamers and non-gamers had statistically similar Strengths and Difficulties Questionnaire scores. There was no association between video gam- ing and being borderline or abnormal in emotional symptoms, conduct problems, hyperactiv ity/inattention, peer relationship problems, prosocial behavior, and total difficulties.

CONCLUSION: This study investigating the relationship between psychosocial well-being and video gaming revealed that video gaming is not associated with psychosocial well-being in preschool age.

PMID:35822480 | DOI:10.5152/TurkArchPediatr.2022.21359