scholarly journals P0740HYPERKALEMIA, CKD AND RAAS INHIBITION: A TRIAD WITH A FINE BALANCE TO PREVENT MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luis Falcao ◽  
Adriana Paixão Fernandes ◽  
Sara Fernandes ◽  
Beatriz Donato ◽  
Mário Raimundo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Mortality Risk ◽  
Therapeutic Agents ◽  
The Other ◽  
Ckd Progression ◽  
Other Hand ◽  
Ckd Stage ◽  
The Impact

Abstract Background and Aims Hyperkalemia (HK) is a common and dangerous complication of CKD because of impaired kidneýs ability for potassium elimination. On the other hand, HK is a common complication of extremely beneficial therapeutic agents acting on the renin–angiotensin–aldosterone system (RAAS). Its initiation at early CKD stages is even more benefic but HK could lead to stop it. We wonder if there is a possible relation between HK, therapeutic changes in RAAS inhibition (not initiating or stopping it) and mortality. Our goal was to investigate incidence, prevalence and clinical outcomes of at least one episode of HK in a CKD population outpatient setting. Additionally, we investigated the association of HK with changes in RAAS inhibition and mortality risk. Method We conducted a patient-level, retrospective, cohort analysis of all adult patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 24 months of follow up and three or more serum potassium determinations. The prevalence of HK (blood potassium level ≥ 5,5mmol/L) at first consultation and incidence during follow up were accessed. Patients were spited in two groups prior to analysis: A) Patients without any HK episode and B) Patients with at least one HK episode. Baseline and follow up covariates included demographics, comorbid conditions, laboratory values, HK-associated drugs [ACEis, ARBs, potassium-sparing diuretics and diuretics]. The impact of HK and therapeutic changes on mortality was evaluated through a logistic regression. Results Out of the 3008 patients referred to the nephrology clinic, 575 (19.1%) met the inclusion criteria (mean age: 70.4 years; 63.7% male and 94.0% caucasians). Mean follow-up was 4.1±1.8 years. Important cardiovascular comorbidities included hypertension (HTN) (90.3%); overweigh (67.4%), DM (49.0%) and Heart Failure (31.4%). CKD stage progression was present in 122 (21.2%). The prevalence of HK at first consultation was 8.7% and follow up incidence 21.7%. From this cohort, 164 (28.5%) had at least on episode of HK (Group B) and 101 (17.6%) died. During the follow up, RAAS inhibition drugs was removed or not started in 200 (34.8%) patients and diuretic was initiated in 165 (28.7%). In univariate analysis, at least one HK episode was associated with Diabetes (65.9 vs 42.3%, p<0.001), Heart failure (36.6 vs 28.0%, p=0.007), Macroalbuminuria (34.1 vs 21.2%, p=0.001), CKD progression (33.5 vs 16.3. p<0.001) higher frequency of diuretic initiation (38.4 vs 24.8%, p<0.001) and higher mortality (27.6 vs 13.7%, p<0.001). In multivariate logistic regression analysis, the independent predictors of mortality were: At least one HK episode (OR 1.82, 95% CI 1.08-3.04, p=0.02); Heart Failure (OR 1.97, 95% CI 1.16-3.35, p=0.01); Older age (OR per 1 year increase 1.04, 95% CI 1.02-1.07, p=0.001); CKD progression (OR 4.18, 95% CI 2.43-7.19, p<0.001). Predictors of lower mortality risk were: Patients who maintained RAAS inhibition during follow up (OR 0.50, 95% CI 0.26-0.96, p=0.03); Patients who started RAAS inhibition during follow up (OR 0.38, 95% CI 0.16-0.88, p=0.02). Conclusion Our study confirms that RAAS inhibition had a protector and independent impact in mortality when prescribed in CKD early stages. On the other hand, patients with at least one episode of HK have a higher risk of mortality. All efforts should be made to maintain these therapeutic agents, looking for other ways to control hyperkalemia rather than stop it.

Growth Differential Factor 15 (GDF%15), Possible Biomarker in Heart Failure

2017 ◽  
Vol 68 (3) ◽  
pp. 631-634
Author(s):  
Valeriu Gabi Dinca ◽  
Gheorghe Manole ◽  
Daniel Cochior ◽  
Alexandra Ligia Dinca
Keyword(s):  
Heart Failure ◽  
Serum Concentration ◽  
The Other ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Other Hand ◽  
The One ◽  
Growth Differential

The present study aims at determining on the one hand the growth differentiation factor 15 significance as possible risk biomarker for this condition and, on the other hand, the degree of correlation between its serum concentration and the class of inotropism deficit.The value of the current research stems from the very selected theme, the activity of GDF-15, member of the superfamily of cytokines TGF-b recognized as having implication in atherosclerosis, but almost unexplored as role in the myocardiumremodeling processes, more precisely in fibrosis.

SCENARIOS FOR AN EXPANDING DEMAND OF TOURISM ON THE COASTS OF CUBA

2017 ◽  
Author(s):  
Oscar Gutiérrez-Bolívar ◽  
Oscar Gutiérrez-Bolívar ◽  
Pedro Fernández Carrasco ◽  
Pedro Fernández Carrasco
Keyword(s):  
United States ◽  
The Other ◽  
Sudden Increase ◽  
Tourist Destination ◽  
Other Hand ◽  
The Usa ◽  
The Impact

The opening of relationships between United States and Cuba could be a drive for a huge increase in the affluence of tourism to Cuba and especially to the coast areas. Cuba has been for many years an important tourist destination for people from many countries, but almost forbidden for US citizens. The proximity of the USA, its amount of population as well as their great acquisition power will increase in a very substantial way the demand for accommodation and other uses in the proximity of the coasts. There will be a need to implement a package of measures that reduce the impact of such sudden increase in the coastal line. On the other hand that augment in tourism could be an opportunity to improve the standard of life of Cubans. The consideration of different possibilities of such development, the analysis of the damages that each one could cause as well as the measures that could avoid, ameliorate or compensate such effects are the goals that are going to be presented in this paper.

Laughter on the Fringes

2019 ◽  
Author(s):  
Anna Peterson
Keyword(s):  
The Other ◽  
Literary Canon ◽  
Autobiographical Writing ◽  
Treasure Trove ◽  
Old Comedy ◽  
Other Hand ◽  
Aggressive Humor ◽  
The One ◽  
The Individual ◽  
The Impact

This book examines the impact that Athenian Old Comedy had on Greek writers of the Imperial era. It is generally acknowledged that Imperial-era Greeks responded to Athenian Old Comedy in one of two ways: either as a treasure trove of Atticisms, or as a genre defined by and repudiated for its aggressive humor. Worthy of further consideration, however, is how both approaches, and particularly the latter one that relegated Old Comedy to the fringes of the literary canon, led authors to engage with the ironic and self-reflexive humor of Aristophanes, Eupolis, and Cratinus. Authors ranging from serious moralizers (Plutarch and Aelius Aristides) to comic writers in their own right (Lucian, Alciphron), to other figures not often associated with Old Comedy (Libanius) adopted aspects of the genre to negotiate power struggles, facilitate literary and sophistic rivalries, and provide a model for autobiographical writing. To varying degrees, these writers wove recognizable features of the genre (e.g., the parabasis, its agonistic language, the stage biographies of the individual poets) into their writings. The image of Old Comedy that emerges from this time is that of a genre in transition. It was, on the one hand, with the exception of Aristophanes’s extant plays, on the verge of being almost completely lost; on the other hand, its reputation and several of its most characteristic elements were being renegotiated and reinvented.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001425
Author(s):  
Marc Meller Søndergaard ◽  
Johannes Riis ◽  
Karoline Willum Bodker ◽  
Steen Møller Hansen ◽  
Jesper Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Heart Rate ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

2021 ◽  
pp. 019459982199338
Author(s):  
Flora Yan ◽  
Dylan A. Levy ◽  
Chun-Che Wen ◽  
Cathy L. Melvin ◽  
Marvella E. Ford ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Sleep Disordered Breathing ◽  
Healthy Children ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

Effectiveness of Virtual Resilience Training on Assertiveness in Student Girls Aged 9–10 Years: A 1-Month Follow-Up

2021 ◽  
pp. 105984052110135
Author(s):  
Shima Gadari ◽  
Jamile Farokhzadian ◽  
Parvin Mangolian Shahrbabaki
Keyword(s):  
Experimental Study ◽  
Internal Stress ◽  
Intervention Group ◽  
The Other ◽  
Hormonal Changes ◽  
Emotional Instability ◽  
Other Hand ◽  
Significant Difference ◽  
Resilience Training

Girls between the ages of 9 and 10 begin to experience physical, physiological, and hormonal changes that may lead to internal stress. At this age, children are struggling for autonomy; on the other hand, they may experience emotional instability, and for these reasons, they may be vulnerable in many ways. This experimental study aimed to investigate the effect of resilience training on assertiveness in student girls aged 9–10. Data were collected before, immediately after, and 1 month after the intervention in the control ( n = 40) and intervention ( n = 37) groups. There was a significant difference between the assertiveness of the intervention immediately (26.80 ± 3.73) and 1 month after the intervention (27.05 ± 3.73), and assertiveness significantly increased in the intervention group ( p = .0001). Resilience training leads to improvements in assertiveness in student girls aged 9–10.

scholarly journals Application of Plant Extracts in Micropropagation and Cryopreservation of Bleeding Heart: An Ornamental-Medicinal Plant Species

Agriculture ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 542
Author(s):  
Dariusz Kulus ◽  
Natalia Miler
Keyword(s):  
Tissue Culture ◽  
Plant Growth ◽  
Plant Growth Regulators ◽  
Growth Regulators ◽  
Plant Extracts ◽  
The Other ◽  
White Gold ◽  
Natural Extracts ◽  
Other Hand ◽  
The Impact

Lamprocapnos spectabilis (L.) Fukuhara (bleeding heart) is valued both in the horticultural and pharmaceutical markets. Despite its great popularity, information on the in vitro tissue culture technology in this species is limited. There is also little knowledge on the application of plant extracts in the tissue culture systems of plants other than orchids. The aim of this study is to compare the utility of traditional plant growth regulators (PGRs) and natural extracts—obtained from the coconut shreds, as well as oat, rice, and sesame seeds—in the micropropagation and cryopreservation of L. spectabilis ‘Gold Heart’ and ‘White Gold’. The biochemical analysis of extracts composition is also included. In the first experiment related to micropropagation via axillary buds activation, the single-node explants were cultured for a 10-week-long propagation cycle in the modified Murashige and Skoog medium fortified either with 1.11 µM benzyladenine (BA) and 1.23 µM indole-3-butritic acid (IBA) or with 10% (v/v) plant extracts. A PGRs- and extract-free control was also considered. In the cryopreservation experiment, the same 10% (v/v) extracts were added into the medium during a seven-day preculture in the encapsulation-vitrification cryopreservation protocol. It was found that the impact of natural additives was cultivar- and trait-specific. In the first experiment, the addition of coconut extract favoured the proliferation of shoots and propagation ratio in bleeding heart ‘Gold Heart’. Rice extract, on the other hand, promoted callus formation in ‘White Gold’ cultivar and was more effective in increasing the propagation ratio in this cultivar than the conventional plant growth regulators (4.1 and 2.6, respectively). Sesame extract suppressed the development of the explants in both cultivars analysed, probably due to the high content of polyphenols. As for the second experiment, the addition of plant extracts into the preculture medium did not increase the survival level of the cryopreserved shoot tips (sesame and oat extracts even decreased this parameter). On the other hand, coconut extract, abundant in simple sugars and endogenous cytokinins, stimulated a more intensive proliferation and growth of shoots after rewarming of samples. Analysing the synergistic effect of conventional plant growth regulators and natural extracts should be considered in future studies related to L. spectabilis.

Education and Learning at a Medieval English Cathedral: Exeter 1380–1548

1981 ◽  
Vol 32 (3) ◽  
pp. 265-283 ◽  
Author(s):  
Nicholas Orme
Keyword(s):  
Sixteenth Century ◽  
Good Deal ◽  
The Other ◽  
Educational Institutions ◽  
Medieval England ◽  
Literary Education ◽  
Other Hand ◽  
The People ◽  
The Impact

During the last hundred years our knowledge of the educational institutions of medieval England has steadily increased, both of schools and universities. We know a good deal about what they taught, how they were organised and where they were sited. The next stage is to identify their relationship with the society which they existed to serve. Whom did they train, to what standards and for what ends? These questions pose problems. They cannot be answered from the constitutional and curricular records which tell us about the structure of educational institutions. Instead, they require a knowledge of the people—the pupils and scholars—who went to the medieval schools and universities. We need to recover their names, to compile their biographies and thereby to establish their origins, careers and attainments. If this can be done on a large enough scale, the impact of education on society will become clearer. In the case of the universities, the materials for this task are available and well known. Thanks to the late Dr A. B. Emden, most of the surviving names of the alumni of Oxford and Cambridge have been collected and published, together with a great many biographical records about them. For the schools, on the other hand, where most boys had their literary education if they had one at all, such data are not available. Except for Winchester and Eton, we do not possess lists of the pupils of schools until the middle of the sixteenth century, and there is no way to remedy the deficiency.

scholarly journals The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia

2021 ◽  
Vol 42 (3) ◽  
pp. 825-833
Author(s):  
Arianna Manini ◽  
Michela Brambilla ◽  
Laura Maggiore ◽  
Simone Pomati ◽  
Leonardo Pantoni
Keyword(s):  
Logistic Regression ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Caregiver Distress ◽  
Neuropsychiatric Inventory ◽  
Logistic Regression Models ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

Abstract Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.

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