Mechanisms Involved in Premature Aging in the Heart—Is There an Implication for Cardiac Surgery?

2017 ◽  
Vol 66 (01) ◽  
pp. 031-041 ◽  
Author(s):  
Andreas Simm ◽  
Susanne Rohrbach ◽  
Bernd Niemann
Keyword(s):  
Cardiac Surgery ◽  
Low Income ◽  
Scoring Systems ◽  
Premature Aging ◽  
Biological Age ◽  
Low Income Countries ◽  
Past Century ◽  
Aged Patients ◽  
Clinical Scoring ◽  
Perioperative Course

AbstractDuring the past century, life expectancy has risen in Germany from 35.6 and 38.5 years in men and women (1871/1881) to 78.2 and 83.1 years (2013/2015). In recent years, the dominance of chronic diseases as major contributors to total global mortality has emerged. The incidence of cardiovascular diseases (CVD) increases in westernized societies and projected trends suggest that by 2030, CVD alone will also be responsible for more deaths in low-income countries than infectious diseases. The occurrence of CVD also seems to correlate to a further increase of biological age within westernized societies. Therefore, age-associated changes in the heart are an issue of high interest in cardiac surgery. The chronological age is a prognostic marker in some clinical scoring systems. However, it does not represent an adequate estimation of the biological age of patients or their perioperative risk. In fact, frailty might be a more powerful predictor for normal perioperative course or risk escalation. An unhealthy, sedentary lifestyle can induce premature aging of vessels and myocardium. Understanding the age-associated genetic, biochemical, and pathophysiological changes can help identify the therapeutic capability of aged myocardium. Future “therapeutic myocardial rejuvenation” may represent a powerful tool for the stabilization of the perioperative course in aged patients. In this review, we will focus on selected mediators or conditions with impact on age-associated myocardial changes with a major focus on obesity and discuss potential therapeutic strategies to utilize or modify these mediators.

scholarly journals THE THE HEPARIN INDUCED THROMBOCYTOPENIA IN CARDIAC SURGERY PATIENTS

2020 ◽  
Vol 70 (6) ◽  
pp. 1919-24
Author(s):  
Shakila Khadim ◽  
Nuzhat Salamat ◽  
Saleem Ahmad Khan ◽  
Kifayatullah . ◽  
Nisaruddin . ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Scoring System ◽  
High Probability ◽  
Scoring Systems ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Medical College ◽  
Simple Strategy ◽  
Clinical Scoring ◽  
And Gender

Objective: Combination of ‘4Ts’ clinical scoring system and Particle gel immunoassay to determine the frequency of heparin-induced thrombocytopenia during heparin treatment in cardiac surgery patients. Study Design: Prospective observational study. Place and Duration of Study: This study was conducted in the Pathology Department, Army Medical College incollaboration with Armed Forced Institute of Cardiology and Armed Forced Institute of Transfusion, Rawalpindi,from Jan 2019 to Dec 2019. Methodology: A total of 115 suspected cases of heparin-induced thrombocytopenia irrespective of age and gender were included in the study. A clinical scoring system the ‘4Ts’ was used for the classification of patients based on probability into three groups such as low, intermediate, and high probability groups. For the detection of antibodies against heparin/platelet factor 4 complexes, the Particle gel immunoassay was used. Results: There were 39 (33.9%) females and 76 (66.1%) males, the age range of 20 to 86 ± 12.9 years. Among the low probability group, there was no positive result, 2 (2.3%) patients showed positive serological evidence in the intermediate probability group. In the high probability group, 4 (23.5%) patients showed positive results with the chosen assay. Conclusion: Heparin-induced thrombocytopenia was found an overall 5.2% of patients undergoing cardiacsurgery receiving unfractionated heparin. A combination of ‘4Ts’ pretest clinical scoring systems followed byPaGIA constitutes a simple strategy to screen for heparin-induced thrombocytopenia in suspected patients. This will avoid serious complications if the detection is not delayed.

scholarly journals Relationship of Risk Factors for Metabolic-Associated Diseases with Biological Age

2021 ◽  
Vol 6 (5) ◽  
pp. 184-192
Author(s):  
O. V. Kolesnikova ◽  
◽  
O. E. Zaprovalna ◽  
A. V. Potapenko
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Life Expectancy ◽  
Premature Aging ◽  
Biological Age ◽  
World Health ◽  
Aged Patients ◽  
Associated Diseases ◽  
Pathological Conditions ◽  
The Impact

Assessment of the rate of aging is of great importance in modern medicine, since people of middle age may have a discrepancy between the calendar and biological age. Biological age is a measure of biological capabilities, which determines not only the past, but also the measures of the forthcoming life expectancy, as well as the risk of certain age-dependent diseases. Metabolic disorders, including hyperglycemia, dyslipidemia, insulin resistance and hyperinsulinemia induce interrelated processes in the vascular wall as well as increase oxidative stress, apoptosis, and vascular permeability therefore contributing to the development of premature aging. The purpose of the study was to establish the relationship between risk factors for metabolic-associated diseases and biological age. Materials and methods. The study involved 119 patients who were divided into 2 groups: 1 group (n = 67) – patients with moderate risk of cardiovascular disease in combination with metabolic-associated diseases (insulin resistance, obesity, hyperuricemia), group 2 (n = 52) – comparison group. Each group was divided into subgroups, depending on age categories: up to 45 years, from 45 years to 60 years (middle-aged patients according to the World Health Organization recommendations), from 60 to 75 years, over 75 years. Results and discussion. Premature aging is diagnosed on the basis of determining the biological age as an indicator of conformity (inconsistency) of the morphofunctional status of the individual to some statistical average development value of this age and sex group. Determination of risk factors for metabolic-associated diseases will effectively counteract the occurrence of pathological conditions and increase life expectancy in these patients. The article presents its own data on the association of risk factors for metabolic-associated diseases, such as smoking, excessive alcohol consumption, body mass index, elevated insulin levels and high levels of proatherogenic lipids, stress level with increasing biological age, both in the study and in the control groups, thus accelerating the rate of aging. Conclusion. Preventive strategies aimed at preventing the impact of risk factors for metabolic-associated diseases will effectively counteract the occurrence of pathological conditions, prevent cardiovascular events (myocardial infarction and cerebrovascular accident), thereby increasing life expectancy in these patients

Children at the Heart of Global Cardiac Surgery: An Advocacy Stakeholder Analysis

2021 ◽  
Vol 12 (1) ◽  
pp. 48-54
Author(s):  
Dominique Vervoort ◽  
Bistra Zheleva ◽  
Kathy J. Jenkins ◽  
Joseph A. Dearani
Keyword(s):  
Cardiac Surgery ◽  
Low Income ◽  
Heart Defects ◽  
Pediatric Population ◽  
Stakeholder Analysis ◽  
Low Income Countries ◽  
Middle Income ◽  
Suboptimal Care ◽  
The World ◽  
Cardiac Surgeons

One in a hundred babies, or 1.3 million per year around the world, are born with congenital heart defects (CHD), of which over 70% will require medical or surgical treatment within their first year of life. In low- and middle-income countries, the majority does not receive the treatment they need or receive suboptimal care. Despite a higher pediatric cardiac surgical disease burden, low-income countries only have 0.07 pediatric cardiac surgeons per million pediatric population, compared to 9.51 per million in high-income countries. Here, we perform a stakeholder analysis of existing advocacy bodies within the field of pediatric global cardiac surgery and identify gaps and opportunities in advocating for cardiac care for children with CHD. We propose a framework to optimize civil society messaging in order to more effectively advocate domestically and internationally to hold national and international policy makers accountable for existing gaps and disparities in CHD care around the world.

scholarly journals Malnutrition and Influencing Factors in Aged Patients: A Hospital-Based Cross-Sectional Study

2021 ◽  
Vol 9 (3) ◽  
pp. 783-790
Author(s):  
Md. Sajib Al Reza ◽  
Md. Abdur Rahim ◽  
Most. Zosnara Khatun ◽  
Vivekananda Biswas ◽  
Nargis Akter ◽  
...  
Keyword(s):  
Low Income ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Cross Sectional Study ◽  
Health Problems ◽  
The Body ◽  
Low Income Countries ◽  
Sectional Study ◽  
Aged Patients ◽  
Cross Sectional

Malnutrition refers to a nutritional ailment that functionally and clinically distresses the body. It is very common in aged people. The nutritional status of this vulnerable group in low-income countries does not remain focused upon. Therefore, this study was designed to investigate the magnitude of malnutrition and to correlate different factors amongst aged patients administered in a reputed Medical College Hospital in Dinajpur district, Bangladesh. An observational cross-sectional study was conducted to evaluate the nutritional eminence of hospitalized aged patients through the original 18-item full Mini Nutritional Assessment (MNA) screening tool. We evaluated 238 patients in this study. Of whom, 144 (60.5%) were men and 94 (39.5%) were women, whose average age were 68.7 ± 7 years. MNA revealed a prevalence of 46.2% for risk of malnutrition, 31.9% for malnutrition, and 21.8% for within normal. Aged patients who lived alone were malnourished than the patients living with others (p < 0.001). Laboratory investigation revealed that malnourished individuals had substantively decreased levels of serum albumin (2.5 ± 0.7 g/dl), hemoglobin (10.3 ± 1.7 g/dl), lymphocytes (1.4 ± 0.9×10^9/L), and cholesterol (150 ± 35.9 mg/dl). About forty-nine and 32.9 percent of individuals with malnutrition had a severe or a moderate decrease in food intakes respectively. Different health problems collectively had influenced malnutrition. Malnourished patients had a tendency to hospitalize for a longer period of time. Thus malnutrition in hospitalized aged patients was highly prevalent and was associated with low food intake, the presence of health problems, and prolonged length of hospital stay.

Applicability of clinical scoring systems after transarterial chemoembolisation in the bridging to transplant setting

2018 ◽  
Vol 56 (08) ◽  
pp. e312-e313
Author(s):  
I Mohr ◽  
M Vogeler ◽  
J Pfeiffenberger ◽  
D Sprengel ◽  
M Klauss ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Transarterial Chemoembolisation ◽  
Clinical Scoring ◽  
Bridging To Transplant

Three Cases of Joubert Syndrome in a Consanguineous Syrian Family and a Interesting Case of Multinational Collaboration

2021 ◽  
Author(s):  
Davor Petrović ◽  
Vida Čulić ◽  
Zofia Swinderek-Alsayed
Keyword(s):  
Low Income ◽  
Autosomal Recessive ◽  
Autosomal Recessive Disorder ◽  
Joubert Syndrome ◽  
Interesting Case ◽  
Low Income Countries ◽  
Ocular Motor ◽  
Quality Health Care ◽  
Quality Health ◽  
Motor Apraxia

AbstractJoubert syndrome (JS) is a rare congenital, autosomal recessive disorder characterized by a distinctive brain malformation, developmental delay, ocular motor apraxia, breathing abnormalities, and high clinical and genetic heterogeneity. We are reporting three siblings with JS from consanguineous parents in Syria. Two of them had the same homozygous c.2172delA (p.Trp725Glyfs*) AHI1 mutation and the third was diagnosed prenatally with magnetic resonance imaging. This pathogenic variant is very rare and described in only a few cases in the literature. Multinational collaboration could be of benefit for the patients from undeveloped, low-income countries that have a low-quality health care system, especially for the diagnosis of rare diseases.

Reviewing the Development of Rural Finance in Vietnam

2013 ◽  
pp. 121-136
Author(s):  
Duong Pham Bao
Keyword(s):  
Low Income ◽  
Financial System ◽  
Low Income Countries ◽  
Supply Side ◽  
New Paradigm ◽  
Rural Finance ◽  
Market Mechanisms ◽  
Rural Credit ◽  
Rural Organizations ◽  
Doi Moi

The objective of this article is to review the development of the rural financial system in Vietnam in recent years, especially, after Doi moi. There are two opposite schools of thought in the literature on rural credit policies in developing countries. One is the conventional supply-side (government-led) approach while the other is called “a new paradigm” that emphasizes the importance of the viability of financial providers and the well functioning of rural credit markets. Conventional theories of rural finance contend that rural finance in low-income countries is generally accompanied by many failures. Contrary to these theories, rural finance in Vietnam does not encounter the above-mentioned failures so far. Up to the present time, it is progressing well. Using a supply-side approach, methodologically, this study reviews the development of the rural financial system in Vietnam. The significance of this study is to challenge the extreme view of dichotomizing between the old and the new credit paradigms. Analysis in this study contends that a rural financial market that, (1) is initiated and spurred by government; (2) operates principally under market mechanisms; and (3) is strongly supported by rural organizations (semi-formal/informal institutions) can progress stably and well. Therefore, the extremely dichotomizing approach must be avoided.

Abdominal Textiloma Mimicking as Left Colic Tumour: A Postoperative Complication Still Common in Low-Income Countries

EMJ Radiology ◽  
2020 ◽  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Low Income Countries ◽  
Fistula Formation ◽  
Emergency Laparotomy ◽  
Intermittent Fever ◽  
Gastrointestinal Complications ◽  
Surgical Safety ◽  
Surgical Teams ◽  
Safety Rules

Retained foreign bodies have become very rare in countries where the safety rules in the operating theatre are very rigorous and follow precise guidelines. There are low-income countries where hospital structures are precarious, in which the implementation of surgical safety rules has only been effective recently. Surgical teams in these countries are not yet well trained in the observance of the guidelines concerning swab count, meaning that textilomas are not uncommon. Abdominal textiloma may be asymptomatic, or present serious gastrointestinal complications such as bowel obstruction, perforation, or fistula formation because of misdiagnosis. It may mimic abscess formation in the early stage or soft tissue masses in the chronic stage. This case report presents a 27-year-old female who underwent an emergency laparotomy in a rural surgical centre for an ectopic pregnancy. Two months later, a swelling had appeared on the left side of her abdomen, gradually increasing in size, which was not very painful but caused digestive discomfort and asthenia. Intermittent fever was described and treated with antibiotics. The patient was referred to a better equipped centre to benefit from a CT scan. A textiloma was strongly suspected on the CT but a left colic mass was not excluded. Laparotomy confirmed the diagnosis of textiloma and the postoperative course was uneventful. Prevention rules must be strengthened in these countries where patients can hardly bear the costs of iterative surgeries for complications that are avoidable.

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