scholarly journals Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease

2021 ◽  
Vol 15 (8) ◽  
pp. e0009680
Author(s):  
Erika Alessandra Pellison Nunes da Costa ◽  
Cassiano Victória ◽  
Carlos Magno Castelo Branco Fortaleza
Keyword(s):  
Chagas Disease ◽  
Cox Regression ◽  
Female Gender ◽  
Southeastern Brazil ◽  
Coronary Syndrome ◽  
Final Multivariable Model ◽  
Cardiac Disorders ◽  
Digestive Disorders ◽  
The Impact ◽  
Chronic Chagas Disease

American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53–3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11–0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03–2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.

Abstract 82: Mnsodtg Mice Exhibit Improved Heart and Mitochondrial Function During Chronic Chagas Disease

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Jianjun Wen ◽  
Craig Porter ◽  
David Herndon ◽  
Nisha J Garg
Keyword(s):  
Chagas Disease ◽  
Mitochondrial Function ◽  
Heart Function ◽  
Heart Tissue ◽  
Oxygen Flux ◽  
Wild Type ◽  
Ros Scavenging ◽  
Scavenging Capacity ◽  
The Impact ◽  
Chronic Chagas Disease

Background: We observed that mitochondrial reactive oxygen species (mtROS) plays very important roles in the pregression of chagesic disease (CD). In this study, we utilized genetically-modified mice to scavenge mtROS to investigate the impact of improved ROS scavenging capacity on heart function in CD. Methods and Results: C57BL/6 mice (wild-type, MnSODtg, MnSOD+/-) were infected with Trypanosoma cruzi(Tc). Chronically infected mice (≥120dpi) exhibited a substantial decrease in heart tissue MnSOD gene expression, protein level, enzyme activity and antioxidant level; decrease of heart dysfunction via lower of SV, CO, EF, FS and LVPW,s, and increase of ESV/EDS and LVID;s; enhancement of hypertrophy by increase of IVS, LV mass and areas duo to augmentation of collagen expressions. One of our novel observations was that sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2) lost its role of maintenance of low cytoplasm free calcium and mediated calcium uptake to intracellular store in Tc-induced chronic chagasic disease. Studies of fresh heart slices using O2K confirmed that Tc diminished heart mitochondrial function like decrease of oxygen flux and respiratory control ratio (RCR), which were caused by enhancements of ROS. Myocardial mitochondrial damage was pronounced and associated with a >x% decline in mitochondrial oxygen flux in chronically infected wild-type and MnSOD transgenic mice. Imaging of intact heart for cardiomyocytes and collagen by the nonlinear optical microscopy techniques showed significant increase in collagen (>x0-fold) in chronically infected wild-type mice; while MnSODtg mice exhibited a basal increase in collagen that did not change during chronic phase. Chronically infected MnSODtg mice exhibited a marginal decline in Tc-induced heart function, heart hypertrophy, mitochondrial dysfunction Conclusions: Overexpression of MnSOD inhibited Tc-induced oxidative damage od heart tissue. , suggesting that enhancing the mitochondrial ROS scavenging capacity was beneficial in controlling the inflammatory and oxidative pathology, and cardiac remodeling responses that are hallmarks of chronic Chagas disease.

P3103Cardiac rehabilitation referral after ACS, are women deprived?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Klein ◽  
R Farkash ◽  
F Bayya ◽  
L Taha ◽  
N Abeles ◽  
...  
Keyword(s):  
Gender Difference ◽  
Reference Group ◽  
Participation Rate ◽  
Female Gender ◽  
Cardiac Risk ◽  
Referral Rate ◽  
P Value ◽  
Coronary Syndrome ◽  
Cox Analysis ◽  
The Impact

Abstract Background Referral and participation rates to Cardiac Rehabilitation (CR) after acute coronary syndrome (ASC) are low despite a Class I recommendation in the present guidelines. Our aim was to examine the role of gender on referral, participation and outcomes of CR. Methods Data of ACS patients hospitalized during 2007–2016 in our cardiology department were extracted and compared between referred to CR to those who were not. Multivariable models were used to assess the impact of gender on referral to CR and survival. Results Of the 6175 ACS patients, 1455 (23.6%) were female. Overall referral rate to CR was 66.5%, 51.3% among female and 70.0% in male; p<0.0001. Female were more likely to have characteristics associated with lower referral rate; they were older, had lower rates of STEMI and higher rates of cardiac risk factors. Multivariable model, adjusted for those characteristics revealed that female gender is independently associated with lower referral rate to CR: OR = 0.77 95% CI [0.66–0.89]; p<0.0001. (Table 1) Multivariable COX analysis showed that patients referred to CR had lower mortality hazard – HR = 0.427 95% CI [0.35–0.53]; p<0.0001, with no gender difference – HR=1.04 95% CI [1.04–1.06]; p=0.640. Participation rate within referred patients, program duration as well as number of meetings were similar in female and male p=NS for all. Independent predictors for CR referral OR 95% CI p-value Cath 6.5 5.3–8.0 <0.001 STEMI** 3.9 3.3–4.6 <0.001 NSTEMI** 2.1 1.8–2.4 <0.001 Smoker 1.9 1.6–2.1 <0.001 Age* 0.9 0.9–1.0 <0.001 Hypertension 0.8 0.7–0.9 0.023 Prior MI 0.8 0.7–0.9 0.032 Female gender 0.8 0.7–0.9 0.001 Prior CABG 0.7 0.6–0.9 0.003 CVA 0.7 0.6–0.9 0.010 PVD 0.7 0.52–0.9 0.033 CHF 0.7 0.6–0.9 0.001 *Age: continuous; **UA as reference group. Conclusions Referral of ACS patients to CR significantly lowers mortality rate. Referral rate of women to CR is significantly lower than men. Once referred to CR, no gender difference was found in CR participation rate and program compliance. Acknowledgement/Funding None

scholarly journals Changing Scenario in Management of Acute Coronary Syndromes in Females—Evidence from Recent Studies

2018 ◽  
Vol 03 (04) ◽  
pp. 245-250
Author(s):  
Akshyaya Pradhan ◽  
Pravesh Vishwakarma ◽  
Rishi Sethi
Keyword(s):  
Cardiovascular Diseases ◽  
Microvascular Disease ◽  
Female Gender ◽  
Daily Practice ◽  
Severe Form ◽  
Reproductive Age ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Atypical Presentations ◽  
The Impact

AbstractCardiovascular diseases are the leading cause of morbidity and mortality worldwide. Acute coronary syndrome (ACS) represents the most severe form of coronary artery disease (CAD) warranting urgent admission and intervention. Conventional teaching dictates that women are free from cardiovascular diseases in their reproductive age group. There is also a high prevalence of microvascular disease and atypical presentations in the fairer sex. Because of these factors, CAD is often under diagnosed and undertreated in women. They are also unfortunately underrepresented in major studies. But it is noteworthy that CAD remains the leading cause of death in both men and women alike. Evidence-based medicine and protocols have led to drastic improvement of outcomes of CAD and ACS. With close to one hundred trials presented at major cardiology meetings, it is impossible for the clinician to keep track of all of them. The authors describe briefly the recent studies in management of STEMI /ACS which have the potential to impact their daily practice. Hence, they also try to assess the impact of female gender on cardiovascular outcomes in these studies.

P4634Acute-phase high platelet reactivity with prasugrel loading is correlated with clinical outcomes during hospitalization in acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Kuroda ◽  
S Gentaro ◽  
K Kawamura ◽  
T Ono ◽  
K Tokioka ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Platelet Reactivity ◽  
Curve Analysis ◽  
Cox Regression Analysis ◽  
High Platelet Reactivity ◽  
Coronary Syndrome ◽  
Post Procedure ◽  
The Impact

Abstract Background/Introduction Although high platelet reactivity (HPR) seems to be associated with adverse cardiovascular events after percutaneous coronary intervention (PCI), the relationship between post-procedure HPR with prasugrel loading and clinical outcomes in acute coronary syndrome (ACS) is still unclear. Moreover, factors contributing to HPR in ACS with prasugrel loading are also unknown. Purpose This study aimed to assess the impact of post-procedure HPR with prasugrel loading on clinical outcomes in ACS during hospitalization, as well as to define appropriate cut-off values and identify factors contributing to HPR. Methods We performed a single-centre, retrospective observational study that enrolled 132 patients who underwent emergent PCI for ACS with prasugrel loading. The P2Y12 reaction unit (PRU) value was measured immediately after PCI with the VerifyNowR System. The primary endpoint was major adverse cardiac events (MACE, defined as the composite of death, myocardial infarction, stroke, heart failure, ventricular arrhythmia needing defibrillation). Results Mean patient age (standard deviation) was 70.7 (±12.5) years, 76% were male, and average time from prasugrel intake to PRU calculation was 101 (±48.8) min. During a mean hospital stay of 15.4 (±8.0) days, there were 22 (16%) MACE events and 6 (4%) deaths. The post-procedure PRU value was 241±66. HPR was significantly higher in MACE group than non-MACE group [287 (±55) vs 232 (±64), p<0.001]. The ROC curve analysis of PRU for discriminating significant in-hospital MACE showed a cut off value of 293 (sensitivity: 64%, specificity: 84% [AUC=0.764, p<0.0001]). Thus, 33 patients (25%) were found to have HPR (PRU>293) immediately after emergent PCI. Kaplan-Meier curve analysis showed MACE events occurred more frequently in the HPR group than in the non-HPR group (42% vs 8%, log rank p<0.001). Multiple Cox regression analysis showed that peak creatine phosphokinase >3,000 U/L and HPR were independent predictors of MACE in patients with ACS who underwent PCI (OR 4.96, 95% CI 1.86–13.26, p=0.001, and OR 7.52, 95% CI 2.73–20.7, p<0.0001, respectively). HPR was significantly correlated with age, female sex, and reference lumen short diameter (pre-dilation) used in PCI. Conclusion HPR was significantly associated with adverse event during hospitalization in ACS patients. Female patients with large culprit lesion diameter were more likely to have HPR. Appropriate cut-off value of HPR in this study was 293. HPR in early-phase of ACS with prasugrel loading is a useful predictor of adverse events during hospitalization.

P0308IMPACT OF MAJOR SURGICAL OPERATIONS ON CLINICAL OUTCOME IN DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rezzan Eren Sadioğlu ◽  
Gizem Kumru Şahin ◽  
Sim Kutlay ◽  
Şule Şengül ◽  
Kenan Keven ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cox Regression ◽  
Perioperative Complications ◽  
Cerebrovascular Event ◽  
Surgical Operation ◽  
Dialysis Patients ◽  
Coronary Syndrome ◽  
Inflammatory Status ◽  
The Impact ◽  
Surgical Operations

Abstract Background and Aims We aimed to study the impact of major surgical operations on clinical outcome in patients with end-stage kidney disease treated with haemodialysis (HD) or peritoneal dialysis (PD). Method We retrospectively evaluated the records of all patients on HD and PD, who had been treated for at least 3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory parameters, data on all major surgical operations were recorded. Results Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. The mean age (±SD) was 58.3±14.5 years, 48% were female and 28% had diabetes mellitus. Forty-seven patients (23%) had a major surgical operation. The operation types were cardiovascular in 14 patients, orthopaedic in 11, gastrointestinal in 8, genitourinary in 6, parathyroidectomy in 5 and brain, pulmonary and breast in 1 patient each. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study population, 59 patients (29%) died during the study period. In Kaplan-Meier analysis (Figure), mean (95% CI) survival time in operated patients was 43 months (37 to 49 months), while it was 49 months (46 to 52 months) in the others (p=0.023). Fifteen out of 23 deaths (65%) among the operated patients occurred in the first month after surgery. Severe perioperative complications (arrhythmias, hypervolemia, hypotension, bleeding, acute coronary syndrome, respiratory failure and cerebrovascular event) were recorded in 17 (36%) of the operated patients, of whom 16 died (p=0.001). Although did not reach a significant level, mortality rate tended to be higher after emergent operations than that after elective operations. Cox regression analyses revealed that age (RR 1.033, 95% CI 1.010-1.057, p=0.005), diabetes (RR 2.581, 95% CI 1.474-4.521, p=0.001), preoperative C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, p&lt;0.0001) and having a major surgical operation (RR 1.868, 95% CI 1.068-3.268, p=0.028) were the independent predictors of mortality. Conclusion Although prospective studies with a higher patient number are needed to confirm, our study shows that, in addition to age, diabetes and inflammatory status, having a major surgical operation is an independent risk factor for mortality in dialysis patients. The prevention and management of perioperative complications properly may result in more favourable outcomes in these patients.

scholarly journals Characterization of digestive disorders of patients with chronic Chagas disease in Cochabamba, Bolivia

Heliyon ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e01206 ◽  
Author(s):  
Jimy-Jose Pinto ◽  
Maria-Jesus Pinazo ◽  
Jaime Saravia ◽  
Ingrid Gainsborg ◽  
Helmut-Ramon Magne ◽  
...  
Keyword(s):  
Chagas Disease ◽  
Digestive Disorders ◽  
Chronic Chagas Disease

Siblings of patients with rheumatoid arthritis are at increased risk of acute coronary syndrome

2019 ◽  
Vol 78 (5) ◽  
pp. 683-687 ◽  
Author(s):  
Helga Westerlind ◽  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Thomas Frisell ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
General Population ◽  
Cox Regression ◽  
Significant Risk ◽  
Coronary Syndrome ◽  
Risk Increase ◽  
Increased Risk ◽  
The Impact

ObjectivesTo investigate a potential shared susceptibility between rheumatoid arthritis (RA) and acute coronary syndrome (ACS) by estimation of the risk of ACS among full siblings of patients with RA.MethodsBy linking nation-wide Swedish registers, we identified a cohort of patients with new-onset RA 1996–2016, age- and sex-matched (5:1) general population comparator subjects, full siblings of RA and comparator subjects, and incident ACS events through 31 December 2016. We used Cox regression to estimate the HR of ACS among patients with RA and the siblings of patients with RA versus the general population, overall and stratified by RA serostatus. We explored the impact of traditional cardiovascular (CV) risk factors on the observed associations.ResultsWe identified 8109 patients with incident RA, and 11 562 full siblings of these. Compared with the general population, the HR of ACS in RA was 1.46 (95% CI 1.28 to 1.67) and 1.22 (95% CI 1.09 to 1.38) among their siblings. The increased risks seemed confined to seropositive RA (patients: 1.52 [1.30 to 1.79], their siblings: 1.27 [1.10 to 1.46]); no significant risk increase was observed among siblings of patients with seronegative RA (HR 1.13 [95% CI 0.92 to 1.39]). Adjustment for 19 traditional CV risk factors did not appreciably alter these associations.ConclusionSiblings of patients with RA are at increased risk of ACS, suggesting shared susceptibility between RA and ACS, indicating the need and potential for additional cardio-preventive measures in RA (and their siblings).

scholarly journals Prasugrel or clopidogrel in patients with acute coronary syndromes at high thrombotic risk: results from the PROMETHEUS study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Chiarito ◽  
D Cao ◽  
Z Zhongjie ◽  
S Sartori ◽  
J Nicolas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Interaction ◽  
Cox Regression ◽  
Risk Profile ◽  
Private Company ◽  
Thrombotic Risk ◽  
Adjusted Risk ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
The Impact

Abstract Background Potent P2Y12 inhibitors are recommended on top of aspirin in patients presenting with acute coronary syndrome (ACS). However, guideline recommendations suggest that the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile. Purpose It is poorly investigated if the benefits derived from potent P2Y12 inhibition in patients with ACS depend on the individual thrombotic risk profile. Our aim was to evaluate if the benefits associated with prasugrel vs. clopidogrel in patients with ACS undergoing percutaneous coronary intervention (PCI) are similar in case of different thrombotic risk profiles. Methods PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. According to the 2020 ESC guidelines for non-ST elevation-ACS, patients are defined at high thrombotic risk if presenting with a clinical (diabetes mellitus requiring medication, history of recurrent myocardial infarction [MI], multivessel coronary artery disease [CAD], polyvascular [coronary and peripheral] disease, premature (&lt;45 years) CAD, and chronic kidney disease [estimated glomerular filtration rate &lt;60 ml/min/1.73m2]) and procedural (≥3 stents implanted, ≥3 lesions treated, total stent length &gt;60 mm, complex revascularization [left main PCI, bifurcation or chronic total occlusion]) risk features. The primary endpoint was major adverse cardiac events (MACE), a composite of death, MI, stroke or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis to assess the effect of prasugrel vs. clopidogrel and with multivariable Cox regression to evaluate the impact of thrombotic risk. Results Among 16065 patients, 4293 were defined at high thrombotic risk and 11772 at low-to-moderate thrombotic risk. Patients treated with prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. Patients at high thrombotic risk had higher rates of both ischemic and bleeding events at 90 days and at 1 year. Patients treated with prasugrel had a lower adjusted risk of MACE at 1 year (HR 0.86, 95% CI 0.77–0.96), with no significant interaction between effect estimates and thrombotic risk. However, after stratifying the study population by the number of risk factors, there was a significant interaction for a greater reduction in MACE with prasugrel in patients with ≤1 thrombotic risk factor. Conversely, there were no differences in major bleeding among patients treated with prasugrel and clopidogrel. Conclusions Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events. Prasugrel, although mainly reserved to patients with lower burden of comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo and Eli Lilly and Company Clinical outcomes at 1 year. Impact of number of risk factors

The Impact of Socioeconomic Conditions on Chronic Chagas Disease Progression

2009 ◽  
Vol 62 (11) ◽  
pp. 1224-1232 ◽  
Author(s):  
Rodolfo Viotti ◽  
Carlos A. Vigliano ◽  
María G. Álvarez ◽  
Bruno E. Lococo ◽  
Marcos A. Petti ◽  
...  
Keyword(s):  
Disease Progression ◽  
Chagas Disease ◽  
Socioeconomic Conditions ◽  
The Impact ◽  
Chronic Chagas Disease

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

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