Confirmatory Results about Spironolactone (S) Effects on AASI in Essential Hypertensive Patients: Short Communication

In this short communication we report complementary data to previous ones, which confirm the effects of spironolactone in reducing AASI, a marker of arterial stiffness, in essential hypertensive patients after 6 months of treatment.

Decreased Heart Rate Variability in COVID-19

On March 12, 2020, the World Health Organization (WHO) announced that the coronavirus disease 2019 (COVID-19) outbreak had become a pandemic. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to Angiotensin-Converting Enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed, not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. We analysed three COVID-19 cases that resulted in death and found that either COVID-19 or antiviral drugs could affect the coupling between the autonomic nervous system and the sinus node, thus affecting heart rate variability and preventing the heart rate from rising in response to the increase in body temperature. Early detection of the preclinical phase of cardiac autonomic dysfunction may help determine patients in need of aggressive treatment and control of cardiovascular risk factors. Antiviral drugs should be used with caution in patients with heart injury.

Improving Rehabilitation for Patients with Intermittent Claudication: A Randomized Controlled Trial with a Mixed-Methods Evaluation (The CIPIC Rehab Study)

Aim: This study aimed to explore how qualitative data about rehabilitation for patients with intermittent claudication do provide an enhanced understanding of the quantitative experimental results. Background: The study was a randomized clinical trial comparing a rehabilitation intervention with usual care. A statistically significant difference between rehabilitation and usual care was found in walking distance, physical activity, quality of life and diet. The findings from the quantitative and qualitative analyses were analysed separately on their own tradition. In this study, mixed methods address whether the qualitative results could help explain the quantitative results and bring forward additional information. Design: Complex mixed-method intervention design with a convergent questionnaire variant. Methods: From April 2017- May 2019, patients diagnosed with intermittent claudication were included in a randomized clinical trial (N=118). In addition, qualitative interview informants from the intervention group were sampled from the quantitative study population for a survey (N=43) and focus group interviews (N=10). Interviews were conducted from April 2018-August 2019. Results: Integrated analyses identified how improvement in walking distance, physical activity, diet and quality of life was affected by team spirit, pedometer, education and fun exercise in a local setting. Quantitative and qualitative findings primarily confirmed and expanded each other; however, two discordant results were also evident. Conclusion: Our study adds empirical evidence regarding how a mixed-methods study can be used to obtain a more nuanced understanding of complex healthcare problems. The study provides new knowledge concerning how to set up a rehabilitation programme for patients with intermittent claudication.

Comparison of Lp-PLA2 Activity, Lp-PLA2 Mass and Lp-PLA2 mRNA in Acute Coronary Syndrome Patients

Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a risk predictor for cardiovascular diseases (CVD). Generally, plasma Lp-PLA2 was thought to be secreted by circulatory inflammatory cells. Lp-PLA2 mRNA expression of PBMC may also be a risk predictor. Methods: A total of 104 subjects angiographically verified ACS patients were enrolled, including 73 unstable angina pectoris (UAP) patients and 31 acute myocardial infarction (AMI) patients. Plasma lipids, Lp-PLA2 activity and Lp-PLA2 mass were measured. Lp-PLA2 mRNA expression of PBMC was relatively quantified by real-time fluorescence PCR. Results: Plasma Lp-PLA2 activity was increased in AMI patients compared to UAP patients (395.21±145.91 vs. 328.53±127.03 U/L, p=0.024). Lp-PLA2 mass of AMI patients was also higher than UAP patients (136.43±45.46 vs. 119.16±44.19 ng/mL, p=0.093), while PBMC mRNA expression was not statistically different [1.07 (0.74, 1.57) vs. 0.88(0.49, 1.99), p=0.453]. Comparing Lp-PLA2 mRNA by groups, Lp-PLA2 mRNA level was higher in male ACS patients and smoking ACS patients (p=0.008, p=0.048, respectively). Multivariate logistic regression analysis showed that Lp-PLA2 activity was an AMI risk predictor (OR=5.224, 95% CI 1.687-16.181, p=0.004), after smoking, systolic blood pressure, diabetes and hyperlipidemia were adjusted. Recurrent ACS patients were older (p=0.035), but they showed lower levels of Lp-PLA2 mass and Lp-PLA2 activity (p=0.014, p=0.045, respectively), compared to primary ACS patients. Conclusion: Smoking may be an important regulatory factor for Lp-PLA2 mRNA expression in PBMC. Among three Lp-PLA2 indexes, Lp-PLA2 activity was the best marker indicating AMI risk, while Lp-PLA2 mass maybe play better role as a predictor in avoiding ACS recurrence.

The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

Patients with opioid use disorder are more likely to get coronavirus disease 2019 (COVID-19). Cardiovascular diseases frequently present in COVID-19 patients and can increase their susceptibility to invasive infectious diseases, such as infective endocarditis (IE). This study examines the difference in IE incidence following COVID-19 diagnosis between individuals with and without non-medical opioid use. De-identified electronic medical records data were retrieved from TriNetX, a web-based database. Patients in the U.S., aged 18-60 years, with a diagnosis of COVID-19 during January 2020 - January 2021 were included in this study. Development of IE was determined within three months after COVID-19 diagnosis. Logistic regression was conducted to estimate the risk of developing IE between COVID-19 patients with and without opioid use after propensity score matching. COVID-19 patients with non-medical opioid use had 6.8 times the risk of developing IE compared with COVID-19 patients without opioid use (95% CI: 5.44, 8.56; p<0.0001) after propensity score matching. Findings suggest a significant risk of IE among COVID-19 patients with a history of non-medical opioid use. It provides objective evidence to account for baseline opioid use in the risk assessment of IE among COVID-19 patients.

Modulatory Effects of L-Arginine on Methylxanthine-Induced Cardiotoxicity in Rats: A Differential Role for Nitric Oxide (NO)

Methylxanthines are potent bronchodilators used in obstructive airway disease like COPD and bronchial asthma, but the narrow therapeutic index and resultant adverse effect profile have restricted their use. Novel beneficial effects and modes of action are now being proposed for these pharmacoeconomically viable agents. Cardiotoxicity is a prominent adverse effect of methylxanthone and thus we investigated possible mechanisms for such toxicity with an aim to devise ameliorative strategies for counteracting such undesirable effects. In view of the cardioprotective role of nitric oxide (NO) and NO mimetics, the present study investigated the possible modulatory role of L-arginine, a NO precursor, in theophylline induced cardiotoxicity in rats, with a view to exploring strategies for facilitating the safe use of this drug. The methylxanthine, aminophylline induced cardiotoxic effects like increased heart rat, raised mean BP, inverted T-waves and prolonged QTc interval (in ECG). These were accompanied by increased levels of cardiac biomarkers like Troponin-I, CPK-MB, and ADMA. Oxidative stress markers like MDA were elevated whereas, antioxidant defence markers like GSH and SOD were suppressed. Co-administration of L-arginine (with aminophylline) had dose-related effects on cardiac function (heart rate, mean BP, ECG changes) and cardiospecific biomarkers (TnI, CPK-MB, ADMA) - the lower dose being protective whereas the higher dose potentiating some of the cardiac effects and cardiospecific/oxidative stress biomarker levels. The results indicate a biphasic involvement of NO in the cardiotoxic effect of theophylline and suggests possible interactions of NO with reactive oxygen species during such modulations of cardiotoxicity.

Application of Cell Culture Models in Studying Viral Diseases (SARS, H1N1 Flu, MERS, COVID-19): A Review

The emergence of recent viral outbreaks, especially the COVID-19 pandemic, and the resulting global mortality and damage has created an urgent need to accelerate the identification, prevention, and treatment of these viral diseases. Due to the limitations in the use of humans, and animal models in terms of time, costs, metabolism differences and ethical issues, in vitro models have become essential in virology research. In the present review, we collected the application of several used cell culture models in studies on four pathogenic viruses - severe acute respiratory syndrome coronavirus (SARS-CoV), influenza A virus (H1N1), middle east respiratory syndrome coronavirus (MERS-CoV), and 2019 novel coronavirus (SARS-CoV-2). These models included, 2D and 3D cell culture (organoids, microfluidic-chips, and bioprinted models). A collection of existing research on these viruses can help fight against the SARS-CoV-2 virus and speed it up against future emerging viruses. Moreover, it can show the shortcomings of in vitro models in virology studies that have been performed to date and provide researchers with new ideas for developing models that are more efficient to deal with similar viral outbreaks.

How to Evaluate the Pulmonary Valve and Right Ventricular Outflow Tract in Prone Position during Invasive Mechanical Ventilation

In the COVID-19 pandemic, we performed a series of echocardiograms using subcostal views. After placing a patient in a prone position during invasive mechanical ventilation, the echocardiogram transducer was placed under the patient in the left subcostal position. This performance allowed us to evaluate the function of the pulmonary valve and estimate pulmonary pressure. This is a complement to the monitoring with a transthoracic echocardiogram in the prone position.

Biofeedback As an Example of Modern Exercise Method Used in Cardiac Rehabilitation

Biofeedback is defined as providing feedback about changes in the patient’s physiological state, by means of stimuli other than those used by the body, usually with the use of technology. This article presents an analysis based on the surveys regarding the awareness of Polish society about biological feedback and its effectiveness in the rehabilitation of patients with cardiac problems. The study was conducted to justify the use in the therapy on people with cardiac problems. The analysis of the patients results after cardiovascular diseases was carried out during the cardiac rehabilitation in which the biofeedback was used.

Impact of Gender on Clinical Characteristic, Treatment and Outcome in ST Elevation Myocardial Infarction: A Hospital Based Study from North-Eastern India

Background: Data on impact of gender on clinical presentation of ST Elevation Myocardial Infarction (STEMI) are sparse in our country. Gender related difference in STEMI has never been studied in North-Eastern India. Aim: The present study was undertaken to study the impact of gender on clinical characteristic, treatment and outcome in STEMI. Methods: We prospectively collected data of 510 STEMI patients from February 2011 to August 2012 in Gauhati Medical College, a tertiary care center in North-Eastern India. We evaluated data on impact of gender in clinical characteristic, treatment, and outcome in STEMI patients. Results: A total of 510 cases of STEMI were included. Females in STEMI were older (53.6 years in males compared to 58 years in females, P<0.001) and have greater atypical presentation (31.6% in females and 13.98% in males, P<0.001). Females also have higher mean time to presentation and higher incidence of diabetes, dyslipidemia, hypertension and high BMI, whereas males had higher incidence of smoking. Females are less likely to undergo thrombolysis (28.73% in females compared to 44.34% in males, p=0.04) and revascularization (17.5% in males and 9.1% in females p-0.01) during index hospitalization, but standard medical therapy was similar. Women were also more likely to develop heart failure either at presentation or at 30 days and also had a higher 30-day mortality (15.5% in female and 9.8% in male, p value-0.06). Conclusion: This study represents the first reported study on impact of gender on clinical presentation of STEMI from North-Eastern India and has observed that females have a higher mean age of presentation, higher incidence of atypical presentation, diabetes, dyslipidemia, hypertension and high BMI. Females also present later than males, though statistically not significant and also less likely to receive thrombolysis and revascularization than males. The 30-day mortality was also higher in females.