peripheral pulse
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Alaaddin Oktar Üzümcügil ◽  
Nihat Demirhan Demirkiran ◽  
Süleyman Kaan Öner ◽  
Alper Akkurt ◽  
Sevil Alkan Çeviker

An 84-year-old male patient with no known comorbidity was admitted to the emergency department with complaints of dyspnea and respiratory distress. The patient was referred to the COVID outpatient clinic, laboratory and radiology tests were performed. Thoracic CT scan of the patient showed large peripheral patchy ground glass densities observed in the lower lobes of both lungs. CT imaging findings were evaluated by an experienced radiologist and reported as COVID-19 pneumonia. The patient, who was self-isolated at home for 5 days, presented to the emergency department again on the fifth day with complaints of respiratory distress, fever, bruising with cough, and loss of peripheral pulse in the left lower extremity. Necessary tests were performed on the patient. An above-knee amputation was performed when a diagnosis of limb ischemic necrosis was made and no revascularization attempt was considered by the CVS department. This case study describes the coexistence of sudden lower extremity thrombosis and Covid-19 in our case without a known chronic disease.

Brittany A Matenchuk ◽  
Katelyn Donna Fujii ◽  
Rachel J Skow ◽  
Frances M Sobierajski ◽  
Christina MacKay ◽  

The objective of the present study was to investigate the relationship between moderate-to-vigorous physical activity (MVPA) and arterial stiffness in pregnancy. Thirty-nine women participated in this study resulting in 68 measurements in non-pregnant (NP; n=21), first (TM1; n=8), second (TM2; n=20), and third trimesters (TM3; n=19). Compliance, distensibility, elasticity, β-stiffness, and carotid to femoral (central) and carotid to finger (peripheral) pulse wave velocity (PWV) were assessed. MVPA was measured using accelerometry. Multilevel linear regressions adjusted for multiple tests per participant using random effects to generate β coefficients and 95% confidence intervals (CI) were performed. Distensibility, elasticity, β-stiffness, central- and peripheral-PWV did not differ between pregnant and non-pregnant assessments. Carotid artery compliance was higher in TM2 compared to NP. Central PWV (β Coef: -0.14, 95% CI: -0.27, -0.02) decreased from early to mid-pregnancy and increased in late pregnancy. Meeting the MVPA guidelines was significantly associated with central-PWV (Adj. β Coef: -0.34, 95% CI: -0.62, -0.06, p=0.016), peripheral-PWV (Adj. β Coef: -0.54, 95% CI: -0.91, -0.16, p=0.005), and distensibility (Adj. β Coef: -0.001, 95% CI: -0.002, -0.0001, p=0.018), in pregnancy. These results suggest that MVPA may be associated with improved (i.e. reduced) arterial stiffness in pregnancy. Novelty Bullets • Central PWV, distensibility, compliance, elasticity, and ß-stiffness, but not peripheral PWV, exhibited curvilinear relationships with gestational age • Central and peripheral PWV were lower in pregnant women who met the physical activity guidelines of 150 minutes of moderate-to-vigorous physical activity per week

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255561
Stamatia Pagoulatou ◽  
Dionysios Adamopoulos ◽  
Georgios Rovas ◽  
Vasiliki Bikia ◽  
Nikolaos Stergiopulos

Ventricular-arterial coupling is a major determinant of cardiovascular performance, however, there are still inherent difficulties in distinguishing ventricular from vascular effects on arterial pulse phenotypes. In the present study, we employed an extensive mathematical model of the cardiovascular system to investigate how sole changes in cardiac contractility might affect hemodynamics. We simulated two physiologically relevant cases of high and low contractility by altering the end-systolic elastance, Ees, (3 versus 1 mmHg/mL) under constant cardiac output and afterload, and subsequently performed pulse wave analysis and wave separation. The aortic forward pressure wave component was steeper for high Ees, which led to the change of the total pressure waveform from the characteristic Type A phenotype to Type C, and the decrease in augmentation index, AIx (-2.4% versus +18.1%). Additionally, the increase in Ees caused the pulse pressure amplification from the aorta to the radial artery to rise drastically (1.86 versus 1.39). Our results show that an increase in cardiac contractility alone, with no concomitant change in arterial properties, alters the shape of the forward pressure wave, which, consequently, changes central and peripheral pulse phenotypes. Indices based on the pressure waveform, like AIx, cannot be assumed to reflect only arterial properties.

Eamon Abdullah ◽  
Jordan B. Lee ◽  
Karambir Notay ◽  
Philip J. Millar

Postprandial superior mesenteric artery (SMA) blood flow is associated with the caloric content of a meal. Whether spectral analysis of a peripheral pulse wave or heart rate can model postprandial SMA blood flow is unclear. We hypothesized that altering the caloric content of a meal would evoke dose-response increases in postprandial SMA hyperemia and distinct changes in the pulse wave harmonic spectrum and heart rate. Twenty healthy subjects (10 male, 26±10 yrs) completed a randomized cross-over trial, comparing three meals (280, 560, or 840 kcal) on SMA blood flow (Doppler ultrasound), heart rate, and the 1st to 7th harmonic amplitudes (derived from a finger pulse wave). Supine SMA diameter and blood velocity were collected at baseline and every 15-minutes throughout 2 hours of postprandial recovery. SMA blood flow was smaller across all time points following meal 1 (280 kcal) compared to both meal 2 (560 kcal) and meal 3 (840 kcal) (All p<0.001), while meal 2 had attenuated responses compared to meal 3 at 60, 90, 105, and 120 minutes postprandial (All p<0.01). Distinct changes in heart rate and the amplitude of 2nd to 5th harmonics were observed between meals (All p<0.05). The changes in harmonic spectrum or heart rate explained 66-69% (adjusted r2) of the variance in postprandial SMA blood flow. These results provide proof-of-concept that easily obtained and non-invasive postprandial harmonic profiles or heart rate may be used to explain changes in SMA blood flow and exploited for the development of wearable technology to non-invasively track caloric intake.

2021 ◽  
pp. 21-23
Anil Kumar ◽  
Md Aiman Khursheed ◽  
Debarshi Jana

INTRODUCTION India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. In the past, the diabetics succumbed to the metabolic complications like ketoacidosis, but now they survive long enough to develop and succumb to the diabetic nephropathy and diabetic foot complications. AIMS AND OBJECTIVES The various predisposing factors for diabetic foot with respect to North Bihar population. To analyse the different ways of clinical presentation of diabetic foot in our hospital. To evaluate the usefulness of surgical management available with special emphasis on strict glycemic control. To determine commonest microorganism/s infecting the diabetic foot patients in the North Bihar Population. MATERIALS AND METHODS Department of General Surgery, DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI. Diabetic patients with foot ulcers admitted in this hospital, according to the WHO criteria, were selected for this study for 1 Year 8 month (April 2019 to December 2020). RESULTS AND ANALYSIS We found peripheral Pulse of 37.9% of the patients was absent. Infection was present in 86.2% of the cases which was signicantly higher (Z=10.23;p<0.0001). Ulcers were mostly at dorsum (22.4%) (Z=1.58;p=0.11) followed by fore foot (13.8%) and great toe (13.8%). Ulcers were mostly right sided (67.2%) followed by left sided (31.0%) (Z=5.12;p<0.001). Only 1(1.7%) patients had bilateral infection. CONCLUSION The prevalence of risk factors for foot ulcer and infections, viz., neuropathy and vasculopathy, are different from the Western literature. Studies from India, suggest predominantly neuropathic ulcers unlike the West where neuroischemia is the most important predisposing factor.As compared to the West, which have predominant Gram-positive infections, centers throughout India have reported a consistent Gramnegative bacterial preponderance in DFI.

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0245026
Weiwei Jin ◽  
Philip Chowienczyk ◽  
Jordi Alastruey

One of the European gold standard measurement of vascular ageing, a risk factor for cardiovascular disease, is the carotid-femoral pulse wave velocity (cfPWV), which requires an experienced operator to measure pulse waves at two sites. In this work, two machine learning pipelines were proposed to estimate cfPWV from the peripheral pulse wave measured at a single site, the radial pressure wave measured by applanation tonometry. The study populations were the Twins UK cohort containing 3,082 subjects aged from 18 to 110 years, and a database containing 4,374 virtual subjects aged from 25 to 75 years. The first pipeline uses Gaussian process regression to estimate cfPWV from features extracted from the radial pressure wave using pulse wave analysis. The mean difference and upper and lower limits of agreement (LOA) of the estimation on the 924 hold-out test subjects from the Twins UK cohort were 0.2 m/s, and 3.75 m/s & -3.34 m/s, respectively. The second pipeline uses a recurrent neural network (RNN) to estimate cfPWV from the entire radial pressure wave. The mean difference and upper and lower LOA of the estimation on the 924 hold-out test subjects from the Twins UK cohort were 0.05 m/s, and 3.21 m/s & -3.11m/s, respectively. The percentage error of the RNN estimates on the virtual subjects increased by less than 2% when adding 20% of random noise to the pressure waveform. These results show the possibility of assessing the vascular ageing using a single peripheral pulse wave (e.g. the radial pressure wave), instead of cfPWV. The proposed code for the machine learning pipelines is available from the following online depository (

Dawid Jedrzejewski ◽  
Ewan McFarlane ◽  
Peter S. Lacy ◽  
Bryan Williams

Central aortic systolic pressure (CASP) can be estimated via filtering of the peripheral pulse wave (PPW) following calibration to brachial blood pressure. Recent studies suggest PPW calibration to mean arterial pressure (MAP) and diastolic BP (DBP) provides more accurate CASP estimates (CASP MD ) versus conventional calibration to systolic BP (SBP) and DBP (CASP SD ). However, the peak of the MAP-DBP calibrated PPW, that is, SBP MD , is rarely reported or used for BP amplification calculations, despite CASP MD being derived from it. We aimed to calculate the unreported SBP MD from studies using MAP-DBP calibration for estimation of CASP MD and compared it with oscillometric brachial SBP (brSBP). Medline database was searched to March 18, 2020. Meta-analysis includes studies reporting noninvasive CASP SD , CASP MD , brSBP, and brachial DBP. SBP MD was calculated using linear function equations. Data from 21 studies used 8 different BP monitors (13 460 participants, mean age: 54±10 years, 57% female, brachial blood pressure: 130±14/79±9 mm Hg). Weighted mean difference between SBP MD and brSBP was 10 mm Hg (range, −2 to 17 mm Hg) and appeared device specific. Calibration of brachial versus radial PPWs to brachial blood pressure showed a greater disparity between SBP MD and brSBP (14 versus 2 mm Hg). BP amplification was similar comparing SBP-DBP versus MAP-DBP calibrations (brSBP-CASP SD versus SBP MD -CASP MD : 9 versus 11 mm Hg), with no instances of reverse BP amplification. PPWs calibrated to MAP-DBP to derive CASP MD generates SBP MD that differs markedly from brSBP with some oscillometric BP monitors. These findings have important implications for BP monitor accuracy, BP amplification, PPW calibration recommendations, and studies of associations between CASP versus SBP and outcomes.

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110131
João Gaspar-Marques ◽  
Teresa Palmeiro ◽  
Iolanda Caires ◽  
Paula Leiria Pinto ◽  
Nuno Neuparth ◽  

Though the approach used to classify chronic respiratory diseases is changing to a treatable-traits (TT) approach, data regarding very elderly patients is lacking. The objectives of this study were to assess TT frequency in very elderly patients and to study the link between extrapulmonary TT and ventilatory defects. Individuals (≥75 years) residing in elderly care centres answered a standardised questionnaire, underwent spirometry, atopy and fractional exhaled nitric oxide assessments and had their blood pressure and peripheral pulse oximetry measured. Pulmonary, extrapulmonary and behavioural TT were evaluated. Outcome variables were an airflow limitation (post-bronchodilator z-score FEV1/FVC<−1.64) and a restrictive spirometry pattern (z-score FEV1/FVC ≥ +1.64 and z-score FVC<−1.64). Seventy-two percent of the individuals who took part in the study ( n = 234) were women, and the median age of participants was 86 (IQR: 7.4). At least one pulmonary TT was identified in 105 (44.9%) individuals. The most frequent extrapulmonary TTs were: persistent systemic inflammation (47.0%), anaemia (34.4%), depression (32.5%) and obesity (27.4). Airflow limitation was exclusively associated with smoking (OR 5.03; 95% CI 1.56–16.22). A restrictive spirometry pattern was associated with cognitive impairment (OR: 3.89; 95% CI: 1.55–9.79). A high frequency of various TTs was found. The novel association between a restrictive spirometry pattern and cognitive impairment highlights the urgency of clinical research on this vulnerable age group.

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