The potential of high-frequency ultrasound Dopplerography in the assessment of microcirculatory disorders in post-COVID-19 patients with a cardiovascular profile

Introduction. Patients with cardiovascular diseases have endothelial dysfunction and a higher risk of severe course of COVID-19, and thrombotic complications. Associated endotheliitis caused by virus penetration and cytokines storm leads to the release of tissue factor, the formation of excess thrombin and fibrin and thrombosis. The aim. To identify the potential of high-frequency ultrasound Dopplerography (HFUDG) for the assessment of microcirculatory disorders in post-COVID-19 patients with cardiovascular profile and to assess the microcirculatory bed condition before and after treatment with sulodexide. Materials and methods. 49 patients recovered from moderate-severe COVID-19 one month ago, aged 20–80, were examined. 24 patients, received prophylaxis with POACs for 1 month, formed group I, group II – 25 patients without prophylaxis. The nail bed of the upper limb 1st finger was examined using HFUDG and a 25 MHz sensor. Shape and spectrum of curves taken from dopplerograms were analyzed. The control examination was performed 4 weeks after therapy. Results. In patients after COVID19, depletion of spectral characteristics was revealed in comparison with dopplerograms of healthy individuals. The predominantly red part of the spectrum corresponding to the fastest particles was recorded. Slow-moving particles corresponding to the lighter part of the spectrum were nearly non-existent. In patients administrated POAC prophylaxis, amplitude indices were higher. Significant increase in D-dimer, antithrombin III, and soluble fibrin monomer complexes (SFMC) was also detected. The remaining parameters of the coagulogram were within the norm before and after treatment. After a course of sulodexide therapy, the spectral characteristics and coagulogram parameters returned to normal. Conclusion. HFUDG allows to detect stasis of capillary blood flow, the appearance of shunt blood flow corresponding to microtrombosis. Microcirculation indicators in post-COVID-19 patients improved after a course of preventive therapy with sulodexide.

Prognostic value of myocardial injury and chronic kidney disease in an emergency unit

Background Cardiac troponin is independently associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). Their joint effect is yet to be clarified. Purpose This study aims to evaluate the prognostic implication of myocardial injury and CKD in patients attended in an emergency room. Methods Retrospective study carried out between January 2012 and December 2013 with consecutive patients attended in an emergency room with troponin determination, who were distributed into four cohorts according to positive troponin and/or glomerular filtration rate (GFR) <45ml/min/ 1.7. We analysed their baseline characteristics and the four-year prognosis. Results 3622 patients were included (median age 68.5 years [IQR 55.5–79.5]; 43% were women). Compared to subjects with normal GFR, the 565 subjects with CKD were significantly older (80.5 vs 66.5 years), with worse cardiovascular profile (arterial hypertension: 87% vs 56%; diabetes mellitus: 46% vs 22%) and greater comorbidity (history of myocardial infarction: 29% vs 18%; heart failure: 17% vs 5%; peripheral vascular disease: 16% vs 5%; cerebrovascular disease: 13% vs 7%%). Myocardial injury was also related to elderly and worse cardiovascular profile and comorbidity, especially in normal GFR subjects. 23.5% (718 subjects) of normal GFR subjects presented with myocardial injury. This percentage was much higher in the presence of renal impairment (331 subjects, 58.6%). Troponin was associated with a higher risk of death (both in-hospital and during follow-up) and of readmission due to infarction or heart failure, regardless of GFR. The reference cohort in the multivariate competing risk mode was that with subjects without myocardial injury or kidney disease. This analysis showed the worst MACE (all-cause death, non-fatal myocardial infarction and heart failure admission) in four-year follow-up in patients with renal impairment and positive troponin (HR 3.94, 95% CI 3.317–4.682), second worst MACE in those with myocardial injury and with normal GFR (HR 2.408, 95% CI 2.064–2.811), and then abnormal GFR patients with negative troponin (HR 1.532, 95% CI 1.220–1.923). Patients with both myocardial injury and renal impairment had the highest mortality (HR 4.633, 95% CI 3.829–5.604) and more readmissions for heart failure (HR 2.163, 95% CI 1.647–2.841). The myocardial-injury-and-normal-GFR cohort showed significantly higher mortality than the renal-impairment-with-negative-troponin cohort (HR 2.669 vs HR 1.794), more heart failure (HR 1.951 vs 1.067) and more myocardial infarctions (HR 2.439 vs 1.235) in the follow-up. Conclusion The results suggest that myocardial injury has better predictive power than chronic kidney disease for MACE events and also for individually mortality, readmission for heart failure or myocardial infarction. FUNDunding Acknowledgement Type of funding sources: None.

Epidemiologic features and Management of Hypertension in Tunisia, the results from the NAtional TUnisian REgistry of HyperTensioN (NaTuRe HTN) about 25890 patients

BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

Cardiovascular profile of crab-eating foxes (Cerdocyon thous) in captivity anesthetized with ketamine and midazolam

The cardiac evaluation of wild animals is still a wide and largely unknown field for several species. Therefore, through complimentary examinations such as radiography, echocardiography and serum troponin levels, this study aimed at describing the values observed in 12 crab-eating foxes (Cerdocyon thous) anesthetized with a combination of intramuscular ketamine and midazolam. Through the use of this chemical restraint, a clinical, radiographic and echocardiographic (linear and indexed values in M-mode) evaluation of the 12 male specimens included in the sample group. Among the findings observed in comparison with domesticated dogs were a decrease in the dimensions of the septum, wall and cavity of the left ventricle, as well as a deceleration in the E wave (EDT), which could be correlated with the maintenance of the serum troponin dosage values (cTnI). Therefore, M-mode echocardiography has proven to be safer and comparative to other species of wild canids when performed through indexed values. In addition, when evaluating the systolic function and segmentary contractions, the anesthetic combination did not have any effects on the results of complementary examinations performed in crab-eating foxes (Cerdocyon thous) included in this study.

Diet intervention improves cardiovascular profile in patients with rheumatoid arthritis: results from the randomized controlled cross-over trial ADIRA

Background The chronic inflammation in patients with rheumatoid arthritis (RA) increases the risk for cardiovascular diseases (CVD). The contribution of diet as a risk factor for CVD among these patients is however not fully understood. The aim of this study is to investigate if a proposed anti-inflammatory diet improves cardiovascular profile in weight stable patients with RA. Methods Patients (n = 50) with RA were included in a cross-over trial. They were randomized to either a diet rich in whole grain, fatty fish, nuts, vegetables and fruit and supplemented with probiotics, or a control diet resembling average nutritional intake in Sweden, for ten weeks. After a 4-month washout they switched diet. Participants received food bags and dietary guidelines. Primary outcome was triglyceride (TG) concentration. Secondary outcomes were total-, high density lipoprotein- (HDL) and low density lipoprotein- (LDL) cholesterol, Apolipoprotein-B100 and -A1, lipoprotein composition, plasma phospholipid fatty acids and blood pressure. Results Forty-seven patients completed at least one period and they remained weight stable. There was a significant between-dietary treatment effect in TG and HDL-cholesterol concentration in favor of intervention (p = 0.007 and p = 0.049, respectively). Likewise, Apolipoprotein-B100/A1 ratio shifted toward a less atherogenic profile in favor of the intervention (p = 0.007). Plasma fatty acids increased in polyunsaturated- and decreased in monounsaturated- and saturated fatty acids between diet periods in favor of the intervention period. Conclusion Blood lipid profile improved indicating cardioprotective effects from an anti-inflammatory dietary intervention in patients with RA. Trial registration This trial is registered at ClinicalTrials.gov as NCT02941055.

Reproductive Biology 2019: Human Chorionic Gonadotropin–Can Nature’s Own Anti-Rejection Agent Help in reducing chronic Rejection in Solid Organ Transplantation?

The safe changes that go with pregnancy are in a fewdifferent ways like those required for strong organtransplantation. Fruitful pregnancy includes controlleddownregulation of the maternal insusceptibleframework with expanded resilience of fetal cellscommunicating fatherly HLA antigens. This has intercededessentially by human chorionic gonadotrophinwhich has an archived capacity to change the activityof T cells, dendritic cells and common executionercells just as expanding vascularisation.Constant unite dismissal is currently the main sourceof join brokenness and disappointment. Long haulhostile to dismissal treatment is joined by safe inadequacyand an unfriendly cardiovascular profile. Interestingly,by and large, insusceptible capacity is savedin pregnancy and pregnant ladies, by and large, feelwell. As such hCG at first added to ordinary treatmentmay lessen or forestall interminable dismissalin transplantation.