bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial Revascularisation in Calcified Aorta in CKD Patient with Help of ENCLOSEII Device, A Bail Out Situation
Authors: Malhotra Rajneesh , Mathur Bhawna , Gupta Pankaj , Gupta Ashok , Kansara Bhuvnesh , Koppula Adarsh
Published: July 2024

In this case, a 56 years dialysis dependent patient presented with complaints of angina at rest for 2 weeks after which she was thoroughly evaluated and was diagnosed with coronary artery disease with calcified aorta along with calcification of other vessels also, following which she was planned for CABG surgery. The unclampable ascending aorta (UAA) is a condition increasingly encountered during CABG procedures[1]. Aging of the population and the increase in patients on dialysis have led to an increasing frequency of “porcelain aorta”[2]. The use of the no-touch technique is associated with a high perioperative risk but a superior possibility of complete revascularisation, whereas the adoption of the no-pump strategy ensures a smoother postoperative course at the expense of a higher incidence of ischemia recurrence[3]. Enclose-II anastomosis assist device was originally developed as an ancillary device for proximal anastomosis in off-pump coronary artery bypass grafting (OPCABG), to assist anastomosis for the vascular grafts without clamping the ascending aorta[3]
Significance of Donath-Landsteiner Antibody Test for Diagnoses of a Rare Case of Paroxysmal Cold Hemoglobinuria with Acute Renal Failure
Authors: Setia Rasika , Dogra Mitu , Handoo Anil
Published: July 2024

Donath Landsteiner (DL) antibodies are biphasic IgG autoantibodies formed in response to a viral or bacterial infection and can induce paroxysmal cold hemoglobinuria (PCH), an autoimmune hemolytic anaemia. It is more frequently seen in children post-infective episodes and is transient and self-limiting in nature. We report a case of a 4.5-year-old male who presented with sudden intravascular hemolysis and AKI with a 2-weekold history of fever and acute viral hepatitis. AKI in PCH is a rarity, and the diagnoses of PCH could only be made correctly with the help of a DL antibody test, which helped with subsequent patient management and avoiding unnecessary treatment escalation.
First Trimester Anomaly Scan
Authors: Khanna Shivani
Published: July 2024

The goal of pregnancy ultrasound scans during the first trimester is to provide accurate information for optimised antenatal care, ensuring the best outcomes for both mother and foetus. Divided into early and late stages, early scans between 6 to 8 weeks focus on determining gestational sac implantation, viability and identifying multiple pregnancies. First-trimester screening, conducted at 11 + 0 to 13 + 6 weeks, includes biometry, anomaly scan, chromosomal abnormality assesment and screening for pre-eclampsia through maternal serum biochemistry. This pictorial essay emphasises the importance of a systematic examination of foetal anatomy during first-trimester screening, aiding in the early detection of structural anomalies. The protocol-based approach ensures reliability in detecting or ruling out abnormalities, allowing for timely counselling and further testing if necessary. While both transabdominal and transvaginal approaches may be utilised, the latter may offer better resolution, especially in certain patient populations. Despite limitations, a comprehensive first-trimester anomaly scan serves as a crucial tool in detecting major foetal abnormalities and providing reassurance to expecting mothers.
FEATURES OF THE TRANSFORMATION OF LOCAL CULTURAL SPACES OF SETTLEMENTS IN WESTERN SIBERIA DURING THE TRANSITION FROM THE SOVIET ERA TO THE PRESENT: IMAGES AND SYMBOLS OF MEMORY OF THE PAST (METHODOLOGICAL ASPECT)
Authors: КУЗНЕЦОВА А.В. , РЫЖЕНКО В.Г.
Published: July 2024

В статье рассматриваются возможности применения междисциплинарной иссле- довательской модели, соединяющей в себе наработки истории, культурологии, гу- манитарной географии, при изучении трансформаций локальных культурных про- странств в период перехода от советской к постсоветской эпохе. Использование методик натурного обследования, анализ источников, применение методов устной истории позволи- ли зафиксировать происходившие трансформации применительно к их пространственному распределению в поселениях разных типов (город-миллионник, малый город, рабочий по- селок, сельское поселение). Выявлено соотношение мест и фигур памяти национального, регионального и локального значения в культурном пространстве разных типов поселений в изучаемый период.

The article examines the possibilities of applying an interdisciplinary research model combining the achievements of history, cultural studies, and humanitarian geography in studying the transformations of local cultural spaces during the transition from the Soviet to the post-Soviet era. The use of field survey techniques, analysis of sources, and the use of oral history methods made it possible to record the transformations that took place in relation to their spatial distribution in settlements of different types (millionaire city, small town, work settlement, rural settlement). The correlation of places and memory figures of national, regional and local significance in the cultural space of different types of settlements in the studied period was revealed.
RIVER OB AS OBJECT OF SCIENTIFIC RESEARCH OF POLITICAL EXILES THE LATE XIX-EARLY XX CENTURIES
Authors: МИЛЕВСКИЙ О.А.
Published: July 2024

В статье рассматривается научная деятельность политических ссыльных, направлен- ная на изучение реки Обь. Обращается внимание на то, что в основном они фокуси- ровали свое внимание на выяснении роли реки в социально-экономической жизни населения Севера Западной Сибири. Особое внимание ими уделялось изучению способов рыбной ловли, специфике организации рыболовных промыслов и тяжелому положению рабочих-промысловиков. Анализируются предложения ссыльных по реорганизации рыбно- го промысла на Оби на более справедливых принципах гуманизации труда, создания арте- лей и кооперации.

The article examines the scientific activities of political exiles aimed at studying the Ob River. Attention is drawn to the fact that they mainly focused on clarifying the role of the river in the socio-economic life of the population of the North of Western Siberia. They paid special attention to the study of fishing methoыds, the specifics of the organization of fisheries and the study of the working conditions of fishing workers. The proposals of the exiles for the reorganization of fishing in the Ob on more equitable principles of humanization of labor, the creation of artels and cooperation are analyzed.
Е. D. MAXIMOV AND THE LEGAL POPULISTS OF THE 1890S
Authors: КИРЕЕВ Д.Ф. , МОКШИН Г.Н.
Published: July 2024

В 1890‑е гг. старое русское народничество вступило в период затяжного идейного кризиса и распада. Не избежали его и легальные народники, призывавшие интел- лигенцию к продолжению культурно-просветительской деятельности в народе, осо- бенно популярной в 1880‑е гг. Данная статья посвящена малоизвестному народническому публицисту и общественному деятелю — Евгению Дмитриевичу Максимову, чье сближе- ние с народниками-культурниками произошло только в середине 1890‑х гг. Интерес к его идейному наследию обусловлен тем, что именно он в начале ХХ в. попытается вдохнуть в теорию «органической культурной работы» С. Н. Кривенко новую жизнь. В статье анали- зируются взгляды Максимова на основные задачи русской жизни и определяется его поло- жение в умеренно правом народничестве.

In the 1890s, the old Russian populism entered a period of protracted ideological crisis and disintegration. Legal populists, who urged the intelligentsia to continue cultural and educational activities among the people, especially popular in the 1880s, did not escape it either. This article is devoted to a little-known populist publicist and public figure, Yevgeny Dmitrievich Maximov, whose rapprochement with the cultural populists occurred only in the mid‑1890s. The interest to his ideological heritage is conditioned by the fact that it was he who in the early twentieth century would try to breathe new life into S. N. Krivenko's theory of "organic cultural work". The article analyzes Maximov's views on the main tasks of Russian life and defines his position in moderate right-wing populism.
REVOLUTIONARY ACTIVITY ON THE EVE OF THE FIRST RUSSIAN REVOLUTION IN THE MIRROR OF GENDARMERIE INQUIRIES (BASED ON THE MATERIALS OF THE SARATOV PROVINCE)
Authors: ХАМИТОВ Д.Р.
Published: July 2024

Статья посвящена изучению революционного движения позднеимперской России начала XX в. Исследовательский ракурс автора сосредоточен на характеристи- ке различных форм революционной деятельности рассматриваемого периода через призму жандармских дознаний. Изучение заявленной в статье проблематики проводится в региональном измерении — на основе архивных материалов Саратовского губернского жандармского управления и местного охранного отделения. Анализ доку- ментов политической полиции позволил определить различные формы революционной деятельности и количество дел, по которым проводилось жандармское дознание на тер- ритории Саратовской губернии накануне первой русской революции.

The article is devoted to the study of the revolutionary movement of late Imperial Russia at the beginning of the XX century. The author's research perspective focuses on the characterization of various forms of revolutionary activity of the period under consideration through the prism of gendarmerie inquiries. The study of the issues stated in the article is carried out in the regional dimension — on the basis of archival materials of the Saratov provincial gendarmerie department and the security department. The analysis of the documents of the political police allowed us to determine the various forms of revolutionary activity and the number of cases in which the gendarmerie inquiry was conducted on the territory of the Saratov province on the eve of the first Russian revolution.
THE IMPORTANCE OF LEGAL REGULATION OF POLITICAL EXILE IN THE CONDITIONS OF THE NORTH OF TOBOLSK AT THE END OF THE XIX CENTURY
Authors: ЯКОВЧУК В.А.
Published: July 2024

В данной статье анализируются особенности политической ссылки на Тобольский Север в контексте изменения ее нормативно-правовой базы. На основании различных исторических источников (нормативно-правовых актов, положений и законопроектов Российской империи, делопроизводственной переписки, источники личного происхождения и пр.) рассматриваются перемены в численном составе ссылки, нюансы регулирования жизни поднадзорных «в местах не столь отдаленных», их материальное и социальное положение. Оценивается роль местной администрации и полиции в повседневности ссыльных. This article analyzes the features of the political exile to the Tobolsk North in the context of changes in its regulatory framework. Based on various historical sources (regulatory acts, regulations and bills of the Russian Empire, office correspondence, sources of personal origin, etc.), changes in the numerical composition of exile, the nuances of regulating the life of supervised persons «in places not so remote», their material and social status. The role of local administration and police in the everyday life of exiles is assessed.

This article analyzes the features of the political exile to the Tobolsk North in the context of changes in its regulatory framework. Based on various historical sources (regulatory acts, regulations and bills of the Russian Empire, office correspondence, sources of personal origin, etc.), changes in the numerical composition of exile, the nuances of regulating the life of supervised persons «in places not so remote», their material and social status. The role of local administration and police in the everyday life of exiles is assessed.
Trabajo y género. Transiciones justas hacia la igualdad laboral real
Authors: Agra Viforcos Beatriz , Álvarez Cuesta Henar , Fernández Domínguez Juan José , González Bustos M.ª Ángeles , Gómez García Francisco Xabiere , López Insua Belén del Mar , Martínez Barroso María de los Reyes , Martínez Yáñez Nora M.ª , Megino Fernández Diego , Morales Vállez Concepción , Ordóñez Pascua Natalia , Rodríguez Escanciano Susana , Tascón López Rodrigo
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
MUJER Y ENFERMEDAD PROFESIONAL A LA LUZ DE LA JURISPRUDENCIA
Authors: Fernández Domínguez Juan José
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
DISCRIMINACIÓN POR GÉNERO, RELIGIÓN Y ETNIA
Authors: Megino Fernández Diego
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
Increasing Tourist Attraction through Aesthetic Development of Kayu Angin Beach, Samaturu Sub-district
Authors: Arjun  , Hamira Sunatul Mutahahir , Febriyanti Annisa , Ardianto Mila Adipati , Ferdi Ferdi , Hasanuddin Hasanuddin , Mujahida Ummul , Syaiful Muhammad , Sapriyadi Sapriyadi
Published: July 2024

Indonesia has many tourist attractions that have an attraction, especially marine tourism, one of the marine tourism that can be visited is Kayu Angin beach. Based on the results of a survey conducted at Kayu Angin beach, it was found that some facilities were outdated and the colors had begun to fade, thus reducing their beauty. At Kayu Angin beach, it is very difficult to find trash bins, and the condition of the coast is very dirty with a lot of garbage. This service activity was carried out to restore beach maintenance and cleanliness and improve beach aesthetics. The method used is participatory observation. The series of activities:  1. Coordinating with the beach manager, 2. Conducting a location survey, and 3. Repainting, providing trash bins, and cleaning the coastline. After this activity the beach atmosphere became more lively and attractive to visitors. Thus, painting, providing trash bins and cleaning the coastline are effective strategies in improving aesthetics and maintaining beach cleanliness. This activity can be implemented continuously by the surrounding community so that the beach is maintained and maintained cleanliness so as to attract tourists to visit.
Perspectivas pedagógicas de la soberanía alimentaria en el currículo ecuatoriano de educación básica elemental
Authors: Rojas Taipe Martha Verónica
Published: July 2024

El presente artículo analiza las perspectivas pedagógicas de la enseñanza del área de la soberanía alimentaria, en el currículo ecuatoriano de educación básica elemental. Con este trabajo será posible determinar las perspectivas pedagógicas sobre la temática citada y, en consecuencia, generar un aporte a la actual práctica educativa ecuatoriana que sirva de referencia a otras áreas del conocimiento y de investigación. El paradigma interpretativo permitió elaborar un marco de referencia para el abordaje de estudios educativos; en cuanto al enfoque de la investigación, esta siguió una visión cualitativa, centrada en un diseño de mapeo bibliográfico a través de la revisión sistemática de la literatura existente; de igual manera, se aplicó el método hermenéutico para analizar e interpretar el contenido de la información recabada.
Para la interpretación de los aportes teóricos en la materia, se efectuó una lectura comprensiva, análisis crítico y categorización de resultados y conclusiones de artículos científicos publicados en las bases de datos SciELO, Dialnet, Scopus y ERIC (Education Resources Information Center). La interpretación de los resultados se desarrolló en tres fases (pasos): arqueo bibliográfico (que identificó 1 539 documentos), el procesamiento, el análisis y discusión de los resultados (con 11 artículos de referencia). Los resultados muestran un escenario en el que la soberanía alimentaria tiene mayor presencia en el ámbito legal, político, económico y productivo, aunque casi no tiene presencia en el ámbito educativo. Sin embargo, es importante generar acciones para el desarrollo e inclusión de programas académicos que incorporen esta materia, con una mirada colaborativa, en los planes de estudio escolares.
Enseñanza y aprendizaje en el espacio escolar para la prevención de drogas en grupos infantojuveniles en Loja-Ecuador
Authors: Soria Duarte Oswaldo
Published: July 2024

El documento se enfoca en la prevención del consumo de drogas en grupos infantojuveniles en el colegio La Dolorosa, de la ciudad de Loja, Ecua­dor, a través de la aplicación de estrategias de enseñanza-aprendizaje. La problemática del consumo de drogas en adolescentes es reconocida como un asunto de relevancia social y de salud que impacta, de manera signi­ficativa, en el desarrollo integral de este sector de la sociedad (Aponte, 2016). La investigación busca identificar cómo la enseñanza-aprendizaje puede contribuir en la prevención del consumo de drogas entre los más jóvenes, establecer la relación entre el consumo de sustancias psicoactivas y la percepción sobre cuáles son los factores de riesgo en el consumo de estas sustancias (Macías et al., 2020). La escuela es un espacio crucial para el desarrollo de los niños y adolescentes, y, por ende, un punto estratégico para ejecutar programas de prevención y educación respecto del consumo de drogas (Cornejo, 2020). La intervención educativa es una herramienta vital que no solo busca informar sobre los riesgos asociados con el consu­mo de drogas, también intenta fortalecer los factores protectores y reducir los riesgos asociados con el consumo, especialmente para este sector.
PSYCHOLOGICAL AND PEDAGOGICAL PROBLEMS OF INTEGRATION OF CHILDREN WITH SPECIAL EDUCATIONAL NEEDS INTO THE STAFF IN PHYSICAL EDUCATION LESSONS IN PRIMARY SCHOOL
Authors: Cholponkulova N. T. , Baytikova T. А. , Sokeeva S. O.
Published: July 2024

The article examines the psychological and pedagogical problems of integrating children of primary school age with special educational needs into the children's team, as a necessary condition for the formation of key social skills necessary in all spheres of social life in the future. As one of the effective ways to solve this problem, the authors propose the implementation of competent design of the educational process in physical education lessons using the psychological and pedagogical resource of outdoor games.The paper presents the results of testing this approach, which indicate an increase in the interpersonal social and business activity of students, the establishment of trusting and respectful relationships between healthy children and a child with special educational needs.
RESHAPING AND RE-STRUCTURING THE JUDICIARY- LAW AND ECONOMIC ANALYSIS
Authors: Agarwal Krishna
Published: July 2024

Rule of law is an important facet of Welfare State. The State is not an end in itself and an obligation is conferred on the State to meet the interests of the citizens. 2 Access to Justice is a basic Fundamental Right granted by the Constitution of India.3 However, its fruits remained confined to a few until the process of adjudication and justice delivery is streamlined in the country, keeping newer challenges in mind. A closer look will reveal that the Rule of Law is directly proportional to the economic growth of the country
IS COVID-19 AN EXCUSE FOR NON-PERFORMANCE AND NON-ENFORCEABILITY OF BUSINESS CONTRACTS? ANSWERS FROM ECONOMIC ANALYSIS WITH A BRAZILIAN PERSPECTIVE.
Authors: Bento Lucas Fulanete G. , Scussel Matheus
Published: July 2024

) In any contract, parties only perform because it is worthy for them, and law surely can influence their behavior making sure it is not worth breaching. (b) Business contracts with different moment of payment can be addressed as a form of investment, since the party that pays first holds the default risk while financing the activity of the counterparty. (c) COVID 19 imposes great burden and uncertainty towards the contracts and courts may aggravate such uncertainty. (d) Statutory or jurisprudence provisions are not prepared for COVID 19. (e) For its characteristics as Business counterparties, neither of the parties are interested in losing a recurrent investor or a recurrent investment. (f) The Coase theorem, once again, shows itself as the best perspective of analysis. Since neither the Courts nor the statutory provisions can interfere efficiently, only the parties, if in a built environment of low transaction costs, will allocate the burdens in an efficient way.
SUBSIDIES TO THE INDIAN SUGAR SECTOR: IN COHERENCE WITH INDIA’S WTO OBLIGATIONS?
Authors: Jha Advik Rijul
Published: July 2024

Recently, Brazil ,Australia and Guatemala have each filed individual requests for Consultation with India at the WTO challenging the domestic support measures and export subsidies provided by India to producers of sugarcane and sugar. The countries claim that these measures are inconsistent with India’s obligations under the WTO Agreement on Agriculture, the Agreement on Subsidies and Countervailing Measures and the General Agreement on Tariffs and Trade, 1994. Thailand, Costa Rica and European Union have also filed requests to join the Consultations5 filed by Brazil, Australia and Guatemala against India. The reason that these countries have approached the WTO against policy incentives given by the Indian government to the sugar industry is that these countries are some of the largest sugar producers of the world6and they fear that India’s sugar exports would lead to a reduction of global prices and thus leading to losses for them.
Electrocardiographic Predictors of Disease Severity, Mortality, and Advanced Ventilatory Support Among Hospitalized COVID-19 Patients: A 2-Year Single- Center Retrospective, Cohort Study From January 2020 to December 2021
Authors: Vista Giovanni A , Vestal Marivic V , Perez Ma. Luisa
Published: July 2024

INTRODUCTION: For detecting myocardial injury in severe and critical COVID-19, the electrocardiogram (ECG) is neither sensitive nor specific, but in a resource-poor environment, it remains relevant. Changes in the ECG can be a potential marker of severe and critical COVID-19 to be used for predicting not only disease severity but also the prognosis for recovery. METHODS: The admitting and interval ECGs of 1333 COVID-19 patients were reviewed in a 2-year, single-center, retrospective cohort study. Each was evaluated for 29 predefined ECG patterns under the categories of rhythm; rate; McGinn-White and right ventricular, axis, and QRS abnormalities; ischemia/infarct patterns; and atrioventricular blocks before univariate and multivariate regression analyses for correlation with disease severity, need for advanced ventilatory support, and in-hospital mortality. RESULTS: Of the 29 ECG patterns, 18 showed a significant association with the dependent variables on univariate analysis. Multivariate analysis revealed that atrial fibrillation, heart rate greater than 100 beats per minute, low QRS voltage, QTc of 500 milliseconds or greater, diffuse nonspecific T-wave changes, and “any acute anterior myocardial infarction” ECG patterns correlate with disease severity, need for advanced ventilatory support, and in-hospital mortality. S1Q3 and S1Q3T3 increased the odds of critical disease and need for high oxygen requirement by 2.5- to 3-fold. Fractionated QRS increased the odds of advanced ventilatory support. CONCLUSION: The ECG can be useful for predicting the severity and outcome of more than moderate COVID-19. Their use can facilitate rapid triage, predict disease trajectory, and prompt a decision to intensify therapy early in the disease to make a positive impact on clinical outcomes. KEYWORDS: advanced ventilatory support, COVID-19 electrocardiographic predictors, disease severity, in-hospital mortality
Dilated Cardiomyopathy in Becker Muscular Dystrophy: A Case Report
Authors: Ines Philipp C , Magno Jose Donato A , Manuel Ronaldo C , Aquino Abdias V
Published: July 2024

BACKGROUND: Becker Muscular Dystrophy (BMD) is a rare X-linked muscular dystrophy, with an incidence of 3 in 100,000 live male births. The most common cardiac presentation is cardiomyopathy (occurs in 50% of cases) and conduction disorders.

CASE: This is a case of a 27 year-old male who was diagnosed with BMD during his childhood. He developed gradual progressive muscle weakness with decrease in basal functional capacity. Dilated cardiomyopathy was observed based on clinical and echocardiographic findings. He was later admitted due to ventricular tachycardia. Upon admission, the chest x-ray showed cardiomegaly. Laboratory examination showed markedly elevated creatine phosphokinase (CPK) isoenzymes. Two- dimensional echocardiography showed generalized hypokinesia with severely depressed systolic function; and dilated left ventricular cavity and left atrium. The hospital course of the patient is herein described.
Noninvasive Hemodynamic Profiling of Patients Undergoing Hemodialysis Using a Handheld Ultrasound Device
Authors: Chua Aileen Paula , Khan Annie Loraine , Paras Danielle Nicole , Rivera Ramon Miguel , Cinco Jude Erric , Sabas Michelangelo
Published: July 2024

INTRODUCTION: Accurate determination of volume status for patients with end-stage renal disease is essential in determining ultrafiltration rate during hemodialysis (HD). To complement the current dry weight method, inferior vena cava (IVC) collapsibility, made accessible by point of-care ultrasonography, is considered. This study determined the utility of IVC measurement in estimating the volume status of patients during HD in comparison to clinical parameters.

METHODS: A single-center cross-sectional design including 53 HD patients was conducted, with IVC measurements done through the Butterfly iQ ultrasound (Butterfly Network, Burlington, Massachusetts).

RESULTS: Most patients were hypervolemic before HD based on weight (94.3%) and IVC collapsibility index (IVC-CI; 75.5%), but only 30% had clinical symptoms. Body weight, maximum IVC diameter, minimum IVC diameter, and indexed IVC size significantly decreased after HD, whereas IVC-CI, blood pressure, and heart rate were unchanged. For the subset of patients with symptoms, absolute values of IVC measures were higher, but did not significantly change after HD, unlike in those without symptoms. For volume classification, there are discrepancies in the classifications based on the different measures, with most improvement seen when weight was used, but which was not reflected in IVC-CI. Change in weight and IVC measures were not significantly correlated.

DISCUSSION: This pilot study showed that the current dry weight method provides ultrafiltration rate estimation without causing intradialytic events. However, IVC can be a supplemental parameter to set higher targets and increase volume removal enough to cause intravascular change, especially in symptomatic patients. The incongruencies in classifying volume status suggest that there is no single measure to determine hemodynamic status and that using multiple parameters may provide a more reliable estimate.

KEYWORDS: inferior vena cava measurement, volume status in hemodialysis, point-of-care ultrasonography
Factors for Uncontrolled Hypertension among Hypertensive Patients Managed by Physicians Practicing in Metro Manila, Philippines
Authors: Pestaño Noemi S , Reyes Eugenio B , Olegario Ivan Noel G
Published: July 2024

INTRODUCTION: The prevalence of hypertension has been rising in the Philippines, with the prevalence being highest in Metro Manila. Surveys showed that blood pressure was controlled in only 20% of hypertensive Filipino patients receiving treatment.

OBJECTIVES: This study aims to determine factors associated with uncontrolled hypertension among hypertensive Filipinos being managed by physicians practicing in Metro Manila.

METHODOLOGY: This is a cross-sectional study involving 1,000 hypertensive patients being treated by 100 physicians in Metro Manila. The patient’s medical records were reviewed, and patients were interviewed, to determine socio-demographics information and 13 patient- and physician-related factors. Based on the last recorded blood pressure, the patients were classified as either having controlled or uncontrolled hypertension.

RESULTS: The prevalence of uncontrolled hypertension is 76%. Multivariate analysis showed that poor blood pressure control was associated with the presence of diabetes mellitus (OR 5.50, 95% CI 3.26-9.27); and current use of two or more drugs (OR 1.57, 95% CI 1.07-2.31). The use of angiotensin receptor blockers (OR 0.5680, 95% CI 0.40-0.79); the use of branded drugs (OR 0.69, 95% CI 0.49-0.98); and treatment supervision by an internist or cardiologist (OR 0.6965, 95% CI 0.4940-0.9818) were associated with good control.
The Cathedral
Authors: Ramirez Marcellus Francis L
Published: July 2024

In this parable, cathedral metaphorically represents an “over-arching vision”.

And vision, is the WHY - or the answer to why we exist as cardiologists and as members of the Philippine Heart Association today. This is what defines our organization, and this is what we are and what we should continue to be - a leader in cardiovascular care, education and research in the Asia Pacific. But ultimately, it is all about decreasing the burden of cardiovascular diseases in the country.
Correlation of RV Strain Imaging Parameters with Cardiac MRI Parameters in the Assessment of RV Function Among Repaired Tetralogy of Fallot Patients
Authors: Mandigma Lorielyn G
Published: July 2024

Background: Strain imaging offers an alternative non-invasive method to quantify right ventricular (RV) function. This study aims to utilize strain imaging in the assessment of RV function among repaired tetralogy of Fallot patients in order to determine clinical RV dysfunction.

Methodology: This is a prospective cross-sectional study done at the Philippine Heart Center. Cardiac magnetic resonance imaging (CMR) and echocardiographic strain imaging were done on the same day for each study participant. Statistical comparison was performed. Sensitivity and specificity curves (using CMR-derived RV ejection fraction [RVEF] as the reference test) was used to determine optimal cut off values for global and regional longitudinal systolic strain and strain rate. Intra-observer variability was also determined.

Results: Twenty-two participants were included. There was significant inverse moderate correlation between CMR-derived RVEF and RV free wall (RVFW) mid-segment strain (r=–0.42; p=0.05) and global longitudinal strain (r= 0.62; p=0.002). The determined cut-off for RV dysfunction for RV global longitudinal strain was –20.66%, which showed a sensitivity of 88.83%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.83%. RVFW mid-segment strain determined cut-off was –16.25, which showed a sensitivity of 83.33%, specificity of 100%, PPV of 100% and NPV of 83.33%.

Conclusion: Strain imaging is an easy, feasible and reproducible parameter in two-dimensional echocardiography that can be a good screening tool, with high sensitivity and specificity for detecting RV dysfunction among patients with repaired tetralogy of Fallot.

Keywords: tetralogy of Fallot, right ventricular dysfunction, strain imaging.
Development of a Clinical Pathway for Acute Coronary Syndrome at Philippine General Hospital
Authors: Tuazon Cecileen Anne M , Alad Paul Anthony O , Rollorazo Albert Roy M , Evangelista Lauren Kay , Agustin Ruth Divine , Ramiro Valerie , Pilapil John Christopher , Velando Bianca , Abaca Mark Joseph M , Mapili Jerahmeel Aleson L , Tamondong-Lachica Diana R , Sison Eric Oliver D , Añonuevo John C , Punzalan Felix Eduardo R
Published: July 2024

BACKGROUND: Acute coronary syndrome (ACS) is a leading cause of admission and mortality in a tertiary care hospital in the Philippines. The significant burden of the disease necessitates that evidence-based care set by international and local guidelines be met to improve service delivery and quality of care (QOC). Institution-specific QOC studies showed gaps between guideline recommendations and compliance. Development and utilization of a clinical pathway are among the identified strategies to improve compliance. It is also crucial for implementation of standard-of-care set specific to a hospital setting based on its needs and resources.

METHODS: This is a descriptive research on the development of a clinical pathway for ACS appropriate for the emergency room setting of a tertiary care hospital from March 2021 to August 2022. Local QOC studies and evidence behind the latest international guideline recommendations on the management of ACS were reviewed to create the interim ACS Pathway. Two-level content validation of the interim pathway was done: internal validation with the consultants and fellows of the Division of Cardiovascular Medicine and external validation through focused group discussions with different hospital units and stakeholders to assess applicability and feasibility based on the resources of the setting, identify hindrances, and propose solutions in its implementation.

RESULTS: An evidence-based clinical pathway for ACS that encompasses identification and management of ST-segment elevation myocardial infarction and non–ST-segment elevation acute coronary syndrome with judicious use of locally available and feasible resources applicable for local emergency room hospital setting was created.

CONCLUSION: Review of local QOC studies and interdepartmental collaboration are necessary components in developing institution-specific clinical pathway for ACS.

KEYWORDS: acute coronary syndrome, clinical pathway, quality of care
Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross-Sectional Pilot Study
Authors: De Vera Julius Caesar , Baltasar-Pelat Jonnah Fatima T
Published: July 2024

Introduction: Strain determination by speckle-tracking analysis has been used worldwide in determining strain in the left ventricle. However, strain determination using speckle-tracking analysis can also be done for the right ventricle. This study aimed to establish the normative data on the right ventricular lateral free wall (RVLFW) strain in healthy Filipino adults.

Methodology: This was a pilot cross-sectional descriptive study on healthy adult Filipinos seen at the St. Luke’s Medical Center−Global City from April 2015 to February 2016. Subjects underwent 2D echocardiography with speckle-tracking analysis. Strain values from the RVLFW segments were calculated using speckle-tracking analysis software. Tricuspid annular plane systolic excursion (TAPSE) was calculated according to American Society of Echocardiography guidelines. Peak systolic velocity at the lateral tricuspid annulus (Sm’) was obtained from pulsed Doppler. Mean RVLFW values were computed and correlated with Sm’ and TAPSE using Pearson’s correlation.

Results: Of the 432 patients initially screened, 66 were included in this study. The mean age was 39±9 years, with male patients comprising 53% of the study population. The mean left ventricular ejection fraction was 65±4.2% The mean TAPSE was 2.1±0.32 cm and the mean Sm’ was 11.6±1.9 cm/s. The speckle-tracking analysis of the RVLFW showed a mean strain of −19.1±6.0% for the basal segment. The mid segment had a mean strain of −26.8± 6.9%, while the apical segment had a mean strain of −26.2±6.4%. The entire lateral free wall had a mean strain of −24.0±4.5%. Females had a significantly higher RVLFW strain value than males. The RVLFW strain was not significantly correlated with TAPSE and Sm’. However, TAPSE was significantly correlated with apical lateral strain (r=0.286; r2=0.082). However, the strength of correlation with the apical lateral strain was weak , explaining only about 8.2% of the variability of apical lateral strain.

Conclusion: This study showed that the mean RVLFW strain in healthy adult Filipinos was −24.0±4.5% (95% CI −22.9% to −25.1%). Furthermore, RVLFW strain in healthy adult Filipinos was not significantly correlated with TAPSE and Sm’.
30-Day Cardiovascular Outcomes of Adult Patients Undergoing Non-cardiac Surgery at the University of Santo Tomas Hospital: A Prospective Cohort Study
Authors: Mendoza Clarissa M , Banez Crismelita , Ramirez Marcellus Francis , Muljadi Nadia , Salazar Janelle
Published: July 2024

BACKGROUND: Approximately 3,500 non-cardiac surgeries are being performed each year in the University of Santo Tomas Hospital (Manila, Philippines). No study has yet been made to evaluate the cardiovascular outcomes of these surgical patients. This prospective cohort study was performed to determine the 30-day cardiovascular outcomes in patients undergoing non-cardiac surgery in the private and clinical divisions of this institution and to evaluate the utility of currently used risk scoring systems.

METHODS: There were 159 adult patients admitted from July to September 2015 for non-cardiac surgery who consented for inclusion. Risk stratification was done using the Revised Cardiac Risk Index (RCRI) and the Gupta Perioperative Risk calculator. They were followed up for major adverse cardiovascular events (MACE) until 30 days after the surgery.

RESULTS: Out of 159 cases, nine patients (5.7%) developed MACE, eight of whom had a cardiac arrest. All major events occurred within 16 days following surgery. The number of comorbidities, presence of chronic kidney disease and emergency surgery significantly predicted perioperative MACE. RCRI had a sensitivity of 88.89%, specificity of 78.37%, positive predictive value (PPV) of 20% and negative predictive value (NPV) of 99.15% for predicting MACE. Gupta Perioperative Risk had a sensitivity of 77.78%, specificity of 84.46%, PPV of 23.3% and NPV of 98.43%. When combined, the two risk scoring systems showed a sensitivity of 88.89%, specificity of 77.70%, PPV of 19.5% and NPV of 99.14%.

CONCLUSIONS: The 5.7% incidence of perioperative cardiovascular complications for non-cardiac surgery was similar to that seen worldwide. Physicians must be vigilant for these complications in the first 16 days following the surgery especially in patients undergoing emergency surgery and who have comorbidities like chronic kidney disease. RCRI is more sensitive while the Gupta Perioperative Risk is more specific and has higher positive predictive value for the occurrence of a MACE. Both scoring indices were useful in risk-stratifying patients.
Association of the Neutrophil–lymphocyte Ratio with Outcomes of Patients Admitted for Acute Coronary Syndrome
Authors: Aherrera Jaime Alfonso M , Chiong Lowe O , Reganit Paul Ferdinand M , Punzalan Felix Eduardo R
Published: July 2024

BACKGROUND: Patients with documented acute coronary syndromes (ACS) have an early risk of death of up to 10%. An elevated leukocyte count has been identified as an independent predictor of an increased risk for long-term mortality and myocardial infarction. An elevated neutrophil count predicts a worse outcome in ACS. In contrast, a low lymphocyte count is related to higher risk of adverse outcomes and mechanical complications, low ejection fraction, high degree of myocardial necrosis and mortality in patients with ACS. The neutrophil-lymphocyte ratio (NLR) integrates the two leukocyte subtype counts with opposing actions in terms of vascular inflammation.

METHODS: This was a prospective cohort study on adult patients admitted for ACS, and had a complete white blood cell count. Patients were stratified into two groups: low to intermediate NLR (NLR ≤6.5) and high NLR (NLR > 6.50). The primary outcome was in-hospital mortality. Secondary outcomes include development or worsening of congestive heart failure (CHF) and the development of cardiogenic shock, re-infarction, dialysis-requiring renal failure, hospital-acquired pneumonia, and arrhythmias.

RESULTS: One hundred seventeen patients were included in the study, with a mean age of 60 years +/- 13. The diagnoses on admission were: unstable angina (28%), non-ST elevation myocardial infarction (34%), and ST elevation myocardial infarction (38%). The odds of in-hospital deaths among those with a high NLR were 5.71 times higher compared to those with low-intermediate NLR (OR 5.71 [1.53-21.23]; p=0.009). Using linear regression, the mean NLR of non-survivors was 9.91, while that of survivors was 5.47. A high NLR was also predictive of the development or worsening of CHF (OR 4.75 [1.47-15.3]; p=0.009), shock (OR 5.0 [1.97-12.67]; p=0.001), re-infarction (OR 6.26 [1.91-20.53]; p=0.002), development of significant arrhythmias (OR 4.12 [1.45-11.7]; p=0.008), and development of any adverse cardiovascular outcome (OR 6.46 [1.40-29.8]; p=0.017).

CONCLUSION: Among patients with ACS, an elevated NLR (>6.5) taken within 24 hours of presentation is a useful marker to predict in-hospital mortality, development or worsening or CHF, and development of shock, re-infarction, and arrhythmias.

KEYWORDS: Neutrophil-lymphocyte ratio, acute coronary syndrome.
Reduction of Infarct Size in Patients with Acute ST Elevation Myocardial Infarction by Postconditioning during Percutaneous Coronary Intervention : A Meta Analysis
Authors: Omambing-Mallillin Edda Mae B , Cheng Frederick
Published: July 2024

BACKGROUND: Following an acute coronary artery occlusion, timely myocardial reperfusion by primary percutaneous coronary intervention (PCI) is the recommended therapy, but restoring blood flow can induce reperfusion injury. Myocardial postconditioning (POC), defined as a sequence of intermittent interruptions of coronary blood flow applied at the onset of reperfusion after a period of sustained ischemia, has been shown to attenuate infarct size and reperfusion injury in patients with acute myocardial infarction undergoing PCI.

METHODS: This is a meta-analysis of the available data from randomized trials on the effects of postconditioning on infarct size, as measured by single-photon emission computed tomography (SPECT) in ST elevation myocardial infarction (STEMI) patients who underwent PCI .

RESULTS: Four randomized control trial studies were identified, comprising 244 patients with STEMI undergoing PCI with or without postconditioning. No adverse events occurred in the postconditioning group. Pooled analysis of all studies demonstrated a significant reduction in infarct size with postconditioning relative to standard care (standard mean difference -0.82, 95% CI -1.10 to -0.55; p=0.00005) as measured by SPECT.

CONCLUSION: Postconditioning is a safe and feasible strategy that may reduce the infarct size in patients with STEMI and confer cardioprotection in the clinical setting.
“To Touch or To Watch”: A Case of Venous Thromboembolism in a Triathlete Complicated by a Mobile Thrombus in the Left Subclavian Vein
Authors: Macabeo Renelene , Canlas Myra A , Fajardo Maria Janelle , Lontok Flordeliz
Published: July 2024

Venous thromboembolism (VTE) encompasses deep venous thrombosis (DVT) and pulmonary  embolism (PE). The reported incidence rates for PE (with or without DVT) range from 29 to 78 per 100,000 person-years whereas for DVT alone (without PE), range from 45 to 117 per 100,000  person-years. It is predominantly a disease of older age, and is rare prior to late adolescence. The  true incidence of VTE among athletes is unknown but several cases have been reported. 

We present the case of a 35-year-old Irish male with no known comorbidities, who presented  with seizures on the tenth hour of a triathlon race and was subsequently diagnosed to have  bilateral segmental pulmonary embolism, upper and lower extremity DVT, complicated by a mobile  thrombus in the left subclavian vein. Anticoagulation was the mainstay of management of this patient and he was eventually discharged improved. A review of literature on VTE, DVT, particularly  upper extremity deep venous thrombosis (UEDVT) and the patient’s hospital course are reported in  this paper.