bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrition and Frailty Status of Patients Undergoing Cardiovascular Surgery and Its Association With Postoperative Outcomes
Authors: D.Patricio Marion , Lagos Bjorn Timothy A , Tan Armand Delo A , Tortosa Christian John  M , Permejo Chito C
Published: July 2024

BACKGROUND: Malnutrition is a component of frailty syndrome characterized by weakness, poor nutritional status, and reduced cognitive function. Frailty has been recognized to adversely affect post–cardiovascular surgery outcomes, with studies primarily in the elderly. To date, there are no published Philippine data on malnutrition and frailty in cardiac surgery patients. 

METHODS: Malnutrition and frailty were assessed preoperatively in 111 adult patients undergoing cardiovascular surgery from October 2020 to February 2021. Nutrition Risk Screening (NRS) tool and Clinical Frailty Scale (CFS) were used for assessment, respectively. Their in-hospital postoperative outcomes were then observed.  

RESULTS: There were 57 patients (51%) diagnosed with malnutrition, 26 (23%) of whom were also frail. Advanced age, rheumatic heart disease, heart failure, and chronic kidney disease were significantly higher in the malnutrition and frail group. After multivariate analysis, mortality rate (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.45–41.91; P = 0.017), prolonged hospitalization (OR, 5.96; 95% CI, 2.14–16.53; P = 0.001), mechanical ventilation (OR, 7.56; 95% CI, 1.81–31.62; P = 0.006), and nosocomial infections (OR, 13.57; 95% CI, 4.41–41.76; P < 0.001) were found higher in patients with malnutrition and frailty. 

CONCLUSION: Evaluation of nutrition and frailty status using NRS and CFS was helpful in predicting postoperative outcomes. With a significant number of this population having malnutrition and frailty, there is a need to strengthen clinical pathways on perioperative nutrition and rehabilitation with the possibility of improving cardiovascular surgery outcomes. 

KEYWORDS: malnutrition, frailty, cardiovascular surgery, postoperative outcomes
A Rat or ARAT? A Case of an Aorta-Right Atrial Tunnel in an Adult with Palpitations and a Continuous Murmur
Authors: Obillos Stephanie Martha O , Pascua Sharon R , Abrahan Lauro L , Aherrera Jaime  Alfonso M , Valones Ariel D , Morales Felimon K , Chiong Lowe L , Magno Jose Donato A , Uy-Agbayani Celia Catherine , Gloria Frederick Philip B , Llanes Elmer Jasper B , Jara Raul D , Leones Louis Mervyn B , Amurao Madelaine F , Dorin Nadia L , Bolos Dolores S
Published: July 2024

The aorta-right atrial tunnel (ARAT) is an extracardiac vascular communication originating from one of the sinuses of Valsalva and terminating in either the superior vena cava or the right atrium. We present a case of this rare phenomenon in a young female with palpitations and a continuous murmur. This case report also presents how various imaging modalities were used to verify the diagnosis.
Steroid Therapy as Prophylaxis to Prevent Coronary Artery Restenosis Among Patients Who Underwent Percutaneous Coronary Intervention Using Bare-metal Stents: A Meta analysis
Authors: Manicad Marlon B , Tan John David S
Published: July 2024

BACKGROUND: One of the current prophylactic interventions to prevent restenosis includes the use of immunosupressants. Marked activation of inflammatory cells at the site of stent plays a role in the process of restenosis. However, clinical trials in humans using prednisone, both oral and intravenous preparations still shows mixed results and needs to be reviewed.

OBJECTIVES: To assess the efficacy of prednisone in preventing coronary artery restenosis among patients who underwent percutaneous coronary intervention (PCI) using bare-metal stents.

METHODS: This is a meta-analysis of randomized, double-blind, placebo-controlled clinical trials using prednisone or its steroid equivalent as intervention for preventing coronary artery restenosis and cardiovascular events among coronary artery disease patients who underwent PCI using bare-metal stents.

RESULTS: Four studies were included in the meta-analysis. Risk ratio of restenosis rates was 0.83 (95% CI 0.59- 1.16). Heterogeneity was moderate (I2=57%). Three studies reported a 12-month event-free survival rate. Prednisone had a risk ratio of 0.55 (95% CI 0.39-0.79); but heterogeneity was moderate.
Single Coronary Ostium Branching into the Right and Left Coronary Artery and Draining into the Pulmonary Artery: A Case Report
Authors: Mojica Joerelle , Llanes Elmer Jasper , Ahererra Jaime , Morales Felimon , Lavente Jodette Joy , Balabagno Maria Margarita , Valones Ariel , Flores Karen
Published: July 2024

This is the case of a 38-year-old female diagnosed with chronic glomerulonephritis and on chronic  hemodialysis who was admitted for worsening heart failure. Physical examination revealed a  continuous murmur in the left parasternal border, which decreased with inspiration. A chest  radiograph revealed an enlarged main pulmonary artery. Transthoracic echocardiogram revealed  a dilated right coronary ostium and a continuous Doppler signal in the main pulmonary artery  (MPA), indicative of a fistula draining into the MPA. A coronary angiogram and cardiac computed  tomography angiogram revealed an absent left main coronary artery and a right coronary artery  (RCA) giving rise to the left anterior descending artery (LAD) and left circumflex artery (LCx). An  arteriovenous fistula from the LAD draining into the MPA was also noted. She was diagnosed with  anomalous origin of the LAD and LCx from the RCA with a coronary arteriovenous fistula from the  LAD, LCx and RCA to the MPA, and end-stage renal failure due to glomerulonephritis. Her heart  failure and renal failure were managed with optimal medical therapy and continuous hemodialysis,  respectively. Surgery was offered to ligate the arteriovenous fistula. This case represents a rare   combination of coronary anomalies. Despite the rarity, such defects should be suspected among  patients presenting with heart failure and a continuous murmur on examination.
Fetal Supraventricular Tachycardia with Hydrops Fetalis in a 20-year old primigravid
Authors: Cabalejo Reynaldo M , Fernandez Arvisminda Luz G
Published: July 2024

INTRODUCTION: Fetal tachycardia can occur in approximately 0.4% to 0.6% of all pregnancies. The most common forms of fetal tachycardias are SVT and atrial flutter. Sustained tachyarrhythmia can lead to congestive heart failure, hydrops, severe neurologic morbidity, or fetal or neonatal demise.

CASE: This is the case of a 20-year old female primigravid who, at 30 weeks age of gestation, experienced increased fetal heart rate. Fetal cardiogram showed a short ventriculo-atrial (VA) interval with a 1:1 atrio-ventricular (AV) conduction, and a rate of 210 to 220 bpm. Amniotic fluid index was 25.34 cm, suggestive of borderline polyhydramnios. Estimated fetal weight was 1,504 g. There was anechoic fluid surrounding the right lung suggestive of pleural effusion with an estimated volume of 12.0 mL. Fetal echocardiography showed an adequate-sized patent foramen ovale; and AV and VA concordance. The patient was first treated with intravenous digoxin, and then oral flecainide. The fetal heart rate converted to sinus rhythm on the 8th day of treatment. There were no immediate maternal and fetal complications noted.
Prediction of Significant Left Main Coronary Artery Disease using ST-segment Elevation in aVR Among Adult Patients with Acute Coronary Syndrome Admitted at a Tertiary Hospital from January 2011 through December 2015
Authors: Lasaca Ciara Kirstine , Acusar Walter
Published: July 2024

Introduction: This study aims to determine whether ST-segment elevation in aVR predicts significant left main coronary artery (LMCA) disease among adult patients with acute coronary syndrome (ACS).

Method: This retrospective study enrolled adult patients, aged 18 years and above, who were diagnosed with ACS, have undergone coronary angiogram, with retrievable electrocardiogram tracings, and were admitted at a tertiary hospital from January 1, 2011 through December 31, 2015.

Results: A total of 276 patients were included in the study, majority of them were male, and the mean age was 60+12 years. Forty-three patients had significant LMCA disease, 18 with ST-segment elevation in aVR; 24 patients had no significant LMCA involvement, with ST-segment elevation in aVR; and 209 had no significant left main disease and did not show ST-segment elevation in aVR.

Conclusion: The study showed that ST-segment elevation of 0.13 mV in aVR has a sensitivity of 92.9%, specificity of 2.1%, likelihood ratio of 0.95, positive predictive value (PPV) of 14.6% and negative predictive value (NPV) of 62.5% in predicting a significant LMCA disease. ST elevation in aVR has high sensitivity but low specificity, LPV and NPV for predicting significant LMCA disease.

Keywords: ECG changes in left main coronary artery disease, ST-segment elevation in aVR.
Chronic Constrictive Pericarditis: The Experience in the Philippine Heart Center and the Philippine General Hospital
Authors: Jara Raul D , Valdez Thessie Minelli O , Roque Jesse Jane R
Published: July 2024

BACKGROUND: Chronic constrictive pericarditis (CCP) in developing countries is usually due to tuberculous pericarditis. This study aims to determine the patient profile, clinical presentations, different diagnostic tests, procedures and outcomes of CCP at the Philippine Heart Center (PHC) and the Philippine General Hospital (PGH).

METHODOLOGY: This was a retrospective study that included all adult patients who were admitted to PHC and PGH for tuberculous pericarditis between January 2010 and December 2013. Characteristics, clinical course and outcomes of patients were described.

RESULTS: The study included 67 patients from PHC and 22 patients from PGH, with a mean age of 38 years. The male-to-female ratios were 2.19:1 for PHC and 3.41:1 for PGH. Dyspnea was the most common complaint, present in 93% of PHC patients and 59% from PGH. Cardiac tamponade was documented by echocardiography in 36% of PHC patients and 46% from PGH. Anti-Koch’s therapy was given to 100% at PHC and 64% at PGH. Pericardiectomy was done on 12% of patients from PHC and 55% at PGH. Perioperative mortality was 3% for PHC and 5% for PGH.

CONCLUSION: CCP is common in tuberculous pericarditis. PHC and PGH varied in their CCP management. Pericardiectomy may improve the outcome of patients with CCP.

KEYWORDS: chronic constrictive pericarditis, tuberculous pericarditis.
Changes in Mitral Annular Displacement and Other Echocardiographic Parameters After TAVI: Philippine Experience
Authors: Cordero Alinaya , Mambulao Ryan , Tiu Joan Ava Kaye , Loquias Marlon , Locnen Sue Ann , Valencia Ofelia , Posas Fabio Enrique
Published: July 2024

OBJECTIVE: The aim of this study was to describe the use of speckle-tracking echocardiography derived mitral annular displacement (STE-MAD) in the assessment of left ventricular (LV) systolic function in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI).

METHODS: This was a retrospective case series that included patients with severely symptomatic AS who underwent TAVI who had baseline transthoracic 2D echocardiography (TTE) and one TTE study ≤ 30-day post-TAVI. In all patients who qualified, STE MAD was then measured in apical 4- and 2-chamber views.

RESULTS: Out of 105 severely symptomatic AS patients who underwent TAVI, 33 patients fulfilled the inclusion criteria. Majority of included patients were male (64%). The average age was 77.15 ± 8.46 years. The most commonly implanted valves were the Lotus valve (39%), the CoreValve prosthesis (33%) and the CoreValve Evolut R prosthesis (28%). There were improvements in the STE-MAD measurements of post-TAVI patients, ranging from 1.433–2.384 mm and 1.935–2.845 mm in the 2C and 4C views, respectively. There was good interobserver and intraobserver agreement in measurements pre- and post-TAVI. Two patients (6.1%) died and seven patients (21.2%) experienced heart failure during the 30-day follow-up period.

CONCLUSIONS: STE-MAD is useful in assessing improvements in systolic function in patients with severe AS post-TAVI.
Correlation of Cardiac Biomarkers with Computed Tomography Severity Score in Covid-19 Patients
Authors: Rivera Ramon Miguel , Cuenza Lucky R , Razon-Cuenza Tamara J , G. Bello Jia An
Published: July 2024

INTRODUCTION: A vast number of COVID-19 cases have been reported worldwide since  the initial outbreak in China, and the disease has since become a global pandemic. Knowledge  on this predominantly respiratory illness is evolving with studies suggesting myocardial injury  reflected by elevated cardiac enzymes portending to more severe disease. CT scoring indices  provide visual, semi-quantitative assessment of lung involvement and have aided in determining  extent of COVID-19 pneumonia but, none have been validated for prognostication. Establishing a  relationship between these non-invasive diagnostic parameters could provide timely identification  and proper allocation of limited medical resources to patients in need of more aggressive therapy. 

METHODS AND RESULTS: A total of 50 COVID-19 patients were retrospectively enrolled and  their clinical parameters collected from an electronic medical database. There was a total of 31  patients with troponin I-HS with chest CT scan done and another 42 patients for NT-proBNP  and chest CT. The levels of both cardiac biomarkers in patients with clinically severe COVID  pneumonia were higher than those with mild and moderate disease. Rank-order analysis showed  that both troponin I-HS (moderate, p=0.0003174) and NT-proBNP (moderate, p=0.006255)  correlated positively with CT severity scores. Furthermore, there is a significant relationship  between mortality and septic shock with both Troponin I-HS (p<0.001; p=0.002) and NT-proBNP  (p=0.004; p=0.031). 

CONCLUSION: The cardiac markers troponin I-HS and NT-proBNP increased significantly at  more severe CT scores and more notably, these biomarkers predicted the development of septic  shock and mortality in COVID-19 pneumonia. 

KEYWORDS: Cardiac Biomarkers, Chest CT, COVID-19, CT Severity, NT-proBNP, Troponin I
Utilization of the Cardiac Rehabilitation Program of Cardinal Santos Medical Center Among Patients Who Underwent Percutaneous Coronary Intervention
Authors: Palafox Charmaine J , Javier-Uy Zenaida
Published: July 2024

OBJECTIVE: The aim of this study is to determine the efficacy of the cardiac rehabilitation (CARE) program of Cardinal Santos Medical Center (CSMC) in patients who underwent percutaneous coronary intervention (PCI), and to determine their improvement in the core components (exercise habits and tolerance, weight, blood pressure, lipid profile, diabetes and tobacco cessation) of CARE.

METHODOLOGY: This is an observational, cross-sectional study and included patients who underwent PCI at CSMC who were enrolled in the CARE program and completed at least Phase 1 of the program. Matched PCI controls were also included. Baseline characteristics and improvements in CARE core components of the two groups were tabulated and compared.

RESULTS: All patients included achieved good blood pressure control and had complete cessation of smoking. Improvement in lipid profile were not significantly different between groups. CARE patients showed greater improvement in physical activity, with an odds ratio of 7 (95% CI 1.73-28.17; p=0.004), showing a strong association between physical activity and CARE.
A Retrospective Cohort Study to Evaluate the Use of Paracetamol Compared to Ibuprofen in the Medical Closure of Patent Ductus Arteriosus Among Preterm Infants in a Private Tertiary Hospital
Authors: Francisco Maria Ronella T
Published: July 2024

OBJECTIVE: To determine the effectiveness and safety of oral and intravenous paracetamol compared to oral ibuprofen in the closure of a patent ductus arteriosus (PDA) in preterm and/or low birth weight infants.

METHODOLOGY: This was a retrospective cohort study involving 28 cases of premature and/or low birth weight infants at a private tertiary hospital from January 1, 2010 until June 30, 2014. Each patient received either oral paracetamol at a dose of 15 mg/kg every six hours for three days or oral ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours.

RESULTS: The PDA closure rates for both paracetamol and ibuprofen were identical at 64.3% (9/14). The mean days of closure for the paracetamol group was shorter at 1.5 ± 0.46 days in contrast to the ibuprofen group, which is 2.7 ± 0.48 days (p<0.001). There were no significant differences between the two groups in the incidence of adverse events. There were more preterm infants that had gastrointestinal bleeding in the ibuprofen group (28.6%) compared to the paracetamol group (7.1%) (p=0.326). Platelet counts in the ibuprofen decreased after one week of treatment at -87 + 115.84, while that of paracetamol group increased by 12 ± 92.34 (p=0.048).

CONCLUSION: We have demonstrated that paracetamol has equivalent efficacy in the closure of PDA compared to ibuprofen, which is the standard drug for the medical treatment of PDA. Paracetamol, with its lower incidence of adverse events, may replace ibuprofen as a drug of choice in the treatment of PDA in preterm infants.

KEYWORDS: preterms, PDA, paracetamol, closure, ibuprofen.
Two-Dimensional Speckle Tracking Echocardiography as Predictor of Major Adverse Cardiac Events in Patients With Non–ST-Elevation Myocardial Infarction and Unstable Angina
Authors: Lacanin Mary Rose Anne E , Tucay Edwin S , Medrano Ana Beatriz R , Ubaldo Rylan Jasper B
Published: July 2024

INTRODUCTION: This study was conducted to determine the utility of two-dimensional speckle tracking echocardiography (2D STE) in predicting major adverse cardiac events (MACEs) in patients with non–ST-elevation acute coronary syndrome (NSTE-ACS). 

METHODOLOGY: This is a prospective cohort study that included 91 patients diagnosed to have NSTE-ACS. In-hospital and 6-month MACEs were evaluated in relation to their baseline echocardiographic parameters, 2D speckle strain, and strain rate analyses. 

RESULTS: Among the conventional echocardiographic parameters, only left ventricular end systolic diameter (LVESD) and wall motion scores showed significant difference between those with and without outcomes after 6 months. Significant higher wall motion scores (24.06 vs 20.91 P = 0.0320) and LVESD (3.36 vs 2.97 cm, P = 0.0125) were noted among those who had MACE after 6 months. There were no significant differences among the 2D STE strain and strain rate between those patients with and without MACE during their hospital admission. However, after 6-month follow-up, significantly lower mean left ventricular global longitudinal strain (GLS) −14.22% ± 4.45% vs −16.44% ± 4.19%, P = 0.0261) and strain rate (−0.69 ± 0.36 s-1 vs −0.94 ± 0.25 s-1, P = 0.009) were observed among patients with MACE compared with those without. Incidence of reduced GLS strain and strain rate was significantly higher in those with MACE after 6 months. Left ventricular GLS sensitivity and specificity were 64.64% and 61.70%, respectively, at a cutoff value of less than −15.0% for detecting MACE within 6 months. Left ventricular GLS cutoff point less than −12.0%, which detects severe LV dysfunction in previous studies, have a sensitivity of 40% but a high specificity of 82.98% for predicting MACE after 6 months. 

CONCLUSION: Both LV GLS strain and strain rate can be used to predict major adverse cardiovascular events after NSTE-ACS. 

KEYWORDS: speckle tracking echocardiography, non–ST-elevation acute coronary syndrome, cardiac events
Clinical Profile and Management Approach of Patients Diagnosed with Resistant Hypertension in the Philippine General Hospital
Authors: Zabat Gelza Mae A , Quiambao Janellen L , Villaverde Ela C , Balibadlan Christine Lorraine D , Oliva Raymond V
Published: July 2024

INTRODUCTION: Resistant hypertension is blood pressure (BP) that remains above target despite treatment with maximum doses of three antihypertensive drugs, which may include a diuretic. The prevalence of resistant hypertension is unknown, and there are no local studies in the Philippines concerning this condition.

METHODS: A retrospective descriptive cohort study was conducted in the Hypertension Clinic of the Section of Hypertension of the Philippine General Hospital. A total of 51 patients were diagnosed with resistant hypertension, and charts were reviewed and analyzed.

RESULTS: Majority of the patients were female (31 [60.8%]), with a mean age of 56.3 years. All of them presented with symptoms; the most common presenting symptoms were headache, exertional dyspnea, nape pain, dizziness, and easy fatigability. Of the 51 patients, 45% also had diabetes mellitus, 11.8% had dyslipidemia, and 7.8% had a previous history of preeclampsia. Approximately 35% of these patients were smokers. The average BP before referral to the section was 167/94 mm Hg. By this time, most patients will either be on a four-drug regimen (42.1%) or a three-drug regimen (36.8%). The median number of visits in the Hypertension Clinic before control of BP was three follow-ups, with the average BP being 119/71 mm Hg. The regimens of the patients with controlled BP are three-drug combination (36.4%), four-drug combination (36.4%), and five-drug combination (27.3%).

CONCLUSION: Early referral to a hypertension specialist may benefit a patient with resistant hypertension, decreasing the number of follow-up visits to control a patient’s BP. Patients with resistant hypertension may require four- to five-drug regimens, which may be needed to adequately control a patient’s BP.

KEYWORDS: drug combination, elevated blood pressure, hypertension, resistant hypertension
Combined Transcatheter Aortic Valve Replacement and Endovascular Aneurysm Repair in a Patient with Severe Symptomatic Aortic Stenosis, Infrarenal Abdominal Aortic Aneurysm and an Adherent Retrosternal Left Internal Mammary Artery Graft
Authors: Enero Janelle D , Ybanez Erwin Jannino O , Carbon-Cuenca Fontini , Posas Fabio Enrique B
Published: July 2024

Transcatheter aortic valve replacement (TAVR) is an effective technique for patients with severe, symptomatic aortic stenosis (AS) who are poor surgical candidates or categorized as intermediate, high or extra-high risk for surgical aortic valve replacement. Likewise, endograft repair techniques such as endovascular aneurysm repair (EVAR) has been shown effective in the management of aortic aneurysmal disease in patients with suitable anatomy.

We present the case of a 73-year old Filipino, male, with a past history of four-vessel coronary artery bypass grafting who presented with severe symptomatic AS, an infrarenal abdominal aortic aneurysm and an adherent retrosternal left internal mammary artery graft that precluded sternotomy, who eventually underwent combined TAVR and EVAR.
Persistent Diffuse Deep T-Wave Inversion an ECG Manifestation of Myasthenia Gravis in Crisis: A Case Series
Authors: Duya Jose Eduardo DL , Buitizon Rodel R , Tumabiene Kristine D , Diestro Jose Danilo , Agbayani Michael Joseph F , Tiongco Richard Henry P
Published: July 2024

Myasthenia gravis (MG) is a disorder with specific autoantibodies directed against the nicotinic acetylcholine receptor (AChR) in the neuromuscular junction. Despite the absence of AChR in the cardiac myocytes, cardiac involvement in MG, ranging from asymptomatic electrocardiogram (ECG) changes to fatal tachyarrhythmias, myocarditis, conduction blocks, heart failure and sudden cardiac death, has been documented in a few case reports. In this case series, we report two cases of MG in crisis presenting with deep diffuse persistent T-wave inversions as markers for possible MG-related cardiac disease.

KEYWORDS: myasthenia gravis, T-wave inversion, electrocardiographic findings.
The Role of Transesophageal Echocardiography in Decision-making During Surgical-based and Catheter-based Cardiac Procedures (TESCO): The Philippine Heart Center Experience
Authors: Fomaneg Cheryl K , Cundangan Melissa R , Rapadas-Ilao Maritoni G , Dumama-Remo Shana Rizza B , Tucay Edwin S
Published: July 2024

Introduction: Studies have shown that intraoperative transesophageal echocardiography (IOTEE) provides important information that may alter patient management and outcome in various cardiac surgeries. This is the first study to report our local experience on the clinical utility of IOTEE and the first paper to include patients who underwent percutaneous cardiac procedures.

Objective: To determine the role of TEE in decision-making during cardiac procedures in our local setting.

Methods: This is a retrospective cohort study involving 465 patients who underwent surgical- or catheter-based cardiac procedures with IOTEE at the Philippine Heart Center from January 2013 to December 2014. Differences in characteristics between patient groups pertaining to IOTEE findings were tested by Fisher’s exact test.

Results: The most common indication for IOTEE in patients who underwent surgical-based procedures was assessment of valve lesion and its severity (83.11%), while guidance of catheter-based intracardiac procedure (100.00%) was the reason for catheter-based interventions. We identified 10.62% of new findings among patients with pre-operative TEE, commonly severe mitral regurgitation (20.33%); the occurrence was lower among patients with additional baseline TEE (p=0.400). Almost all of these new findings initiated alteration of procedures (10.40%). More than half (59.57%) of these procedures were extended and were mostly combination procedures like CABG + MV repair (17.86%). On the other hand, 15.60% of pertinent findings were detected in patients with post-operative TEE; 9.45% were related to the previously operated structure, while 6.15% pertained to other structures, and the most common finding was moderate tricuspid regurgitation. These findings initiated reoperation in 2.86% and repeat reoperation in 1.10%, with MVR as the leading reoperation procedure (33.33%). There were 11.65% findings that remained unoperated, most frequently moderate TR. The incidences of new findings (20.00% vs 10.41%; p=0.288) and alterations (20.00% vs 10.18%; p=0.279) were higher in patients with pre-operative TEE alone than those with pre-operative + post-operative TEEs. Also, the incidences of pertinent findings (23.08% vs 15.38%; p=0.437) and reoperations (15.38% vs 3.62%; p=0.089) were higher in patients with post-operative TEE alone than in patients with pre-operative + post-operative TEE.

Conclusions: The role of TEE during surgical-based and catheter-based cardiac interventions remains substantial. Hence, it should be used routinely in patients undergoing cardiac procedures.

Keywords: transesophageal echocardiography, decision-making, surgical- based cardiac procedures, catheter-based cardiac procedures.
Catheter Ablation Versus Non-Ablative Strategies for Ventricular Tachycardia in Patients with Ischemic Cardiomyopathy on Implantable Cardioverter-Defibrillator: A Systematic Review and Meta-Analysis
Authors: Buaya Carlo Andrew A , Junia Alex T , Chan Keith Andrew , Alcazar Jeremy Anne
Published: July 2024

Background: Ventricular tachycardia (VT) is an abnormal rapid rhythm originating from the lower ventricles occurring commonly in patients with cardiomyopathic hearts. Three treatment options are available: implantable cardioverter defibrillator (ICD), antiarrhythmic medications or catheter ablation (or a combination of these options). This systematic review aimed to compare the efficacy of catheter ablation vs non-ablative techniques as treatment for VT in patients with ischemic cardiomyopathy.

Methods: This was a systematic review and meta-analysis of prospective studies that compared ablative vs non-ablative strategies in patients with ischemic heart disease and depressed left ventricular ejection fraction (LVEF). Outcomes of interest included the post-treatment rate of recurrent VT, appropriate ICD shocks and mortality.

Results: Pooled findings of five studies showed a non-significant difference in the odds of VT post-treatment between the ablation arm and the non-ablation arm (OR 0.61; 95% CI 0.34-1.10; p=0.10). Heterogeneity was high (I2=55%). Sensitivity analysis excluding one pilot study contributing to the heterogeneity revealed a statistically significant reduction in the odds of recurrent VT (OR 0.54; 95% CI 0.31-0.94; p=0.0.03). Pooled findings of four studies showed that ablation resulted in a lower rate of appropriate shocks post-treatment compared with the non-ablative group (OR 0.51; 95% CI 0.30-0.87; p=0.01. There was no significant difference in the mortality rate between catheter ablation and non-ablative strategies (OR 0.77; 95% CI 0.47-1.25; p=0.29).

Conclusion: Catheter ablation on top of ICD placement reduced the risk of post-treatment VT and appropriate shocks. However, these did not translate into a reduction in mortality.

KEYWORDS: catheter ablation, non-ablative strategies, implantable cardioverter defibrillator, ischemic cardiomyopathy.
Long QT Syndrome in a 10-year Old Boy Presenting with Seizure
Authors: Portigo Eleanor Florencia M , Lagamayo Magdalena
Published: July 2024

BACKGROUND: Arrhythmias in children may be benign or life threatening. Some may produce only mild, non-specific symptoms. Thus, specific documentations of arrhythmia, such as electrocardiogram and Holter monitoring, correlated with reported symptoms, are critical in establishing the diagnosis. Long QT syndrome (LQTS) is rare in pediatric patients compared with adults. It may either be inherited or acquired, and results in abnormalities in the ventricular repolarization leading to ventricular arrhythmia, which can be fatal.

CASE: This is the case of a 10-year old male who presented for the first time with generalized seizure associated with appearance of arrhythmia during active seizure. Video electroencephalography showed no definite epileptiform discharges. However, there were episodes of ventricular tachycardia (VT) progressing to ventricular fibrillation, with sudden loss of body tone. Electrocardiography showed prolonged corrected QT interval of 0.68 s with T wave alternans. Lidocaine drip was started. Holter monitor showed frequent episodes of T wave alternans, fusion beats and non-sustained polymorphic VT and Torsade des Pointes. With this diagnostic tests pointing to LQTS, he was given propranolol at a dose of 0.5 mg/kg body weight every 6 hours, and phenytoin. There was no recurrence of VT, and seizure was controlled. He was sent home with propranolol and phenytoin as home medication. Genetic testing done on follow-up was consistent with a genetic form of LQTS at gene SCN5A (LQTS3).

CONCLUSION: This is the first reported case of a diagnosed LQTS in a pediatric patient at Philippine Heart Center. LQTS is a cardiac electrical disorder. It is often difficult for the families of affected individuals to understand this rare cardiac disease. Seizure is one of the symptoms of LQTS, caused by ventricular arrhythmia and can be fatal. Thus, the importance of obtaining an electrocardiogram in patients with seizure is always emphasized. Genetic testing is recommended to determine the specific genotype as a guide to treatment. Once established, genetic counselling is also recommended to discuss to the family the implications of the disease, and the risk of recurrence.
Quantification of Reflux Velocity by Duplex Ultrasound in Superficial and Deep Venous Insufficiency and its Correlation in the Assessment of the Clinical Stage of Chronic Venous Insufficiency
Authors: Ibrahim Aliah , Ganzon Simonette
Published: July 2024

OBJECTIVE: This study aimed to determine the correlation between ultrasound-derived  parameters of chronic venous insufficiency (CVI) and the clinical stage of disease. 

METHODS: This was a cross-sectional study conducted in a tertiary hospital and included all  adult patients who underwent venous duplex ultrasound of the lower extremities with reflux of the  superficial and/or deep venous system. The following parameters were measured: vein diameter,  reflux duration, peak systolic velocity (PSV), mean diastolic velocity (MDV) and total reflux volume  (TRV). Spearman’s Rank-Order coefficient was used to determine the correlation between  ultrasound parameters versus the clinical stage of CVI (C0-C6).  

RESULTS: There was a weak but statistically significant correlation between clinical stage and  MDV in the right peroneal (r=0.240), left femoral (r=0.175) and left popliteal (r=0.192); between  clinical stage and PSV in the right peroneal vein (r=0.194); and between clinical stage and TRV in  the right peroneal (r=0.186), left great saphenous (r=0.167), left femoral (r=0.194) and left popliteal  veins (r=0.201). 

CONCLUSION: There is a statistically significant correlation between the clinical stage of CVI and  MDV, PSV and TRV, although the correlations are weak. 

KEYWORDS: Duplex-derived parameters, chronic venous insufficiency
Outcomes of Intravascular Ultrasound Guided-Percutaneous Coronary Intervention versus Conventional Percutaneous Coronary Intervention: A Meta-analysis of Randomized Controlled Trials
Authors: Tomandao Kathy Lou B
Published: July 2024

BACKGROUND: Coronary angiography has been the standard test in evaluating coronary artery disease. However, this procedure has its limitations in estimating disease severity. Intravascular ultrasound (IVUS) promises to be a more sensitive tool for correct assessment of true lumen dimensions and architecture, as well as atherosclerotic plaque burden and vessel wall abnormalities. The use of IVUS during percutaneous coronary intervention (PCI) may therefore optimize the results of PCI, particularly of stent implantation. In addition, IVUS provides the operator with better information on real vessel size, which facilitates device selection.

The objective of this study was to compare the outcomes of patients who underwent IVUS guided PCI versus conventional PCI after 12 months based on target lesion revascularization, death and all-cause mortality, myocardial infarction and any major adverse coronary event (MACE).

METHODS: This was a meta-analysis that included published randomized controlled trials that compared the outcomes of patients who underwent IVUS guided-PCI versus conventional PCI. Included trials were searched from electronic databases, such as Pubmed, ClinicalTrials.gov, and HighWire. Results of identified studies that reported the outcomes of on target lesion revascularization, death and all-cause mortality, myocardial infarction (MI) and any major adverse cardiac event (MACE) were tabulated and subjected to meta-analysis.

RESULTS: A total of seven randomized clinical trials were included in this meta-analysis, including a total of 6,370 patients. The primary endpoint of target lesion revascularization at 12 months was significantly lower in patients who underwent IVUS-guided PCI (RR 0.66; 95% CI 0.55, 0.79; p<0.001) compared with conventional PCI. Death and all-cause mortality were higher in the conventional PCI group compared with the IVUS-guided PCI group (RR 0.78; 95% CI 0.62, 0.98; p=0.037). The incidence of myocardial infarction and any MACE showed no significant difference between the two groups.

CONCLUSION: This study showed that IVUS-guided PCI resulted in lower target lesion revascularization and mortality rate at 12 months when compared with conventional PCI. Both groups resulted in similar outcome in terms of MI and any MACE at 12 months.
Confiscation of assets in the EU – legal or (just) effective?
Authors: Hryniewicz-Lach Elżbieta
Published: July 2024

The European Union is empowered to legislate in criminal matters; the European Parliament and the Council may establish minimum rules, in certain areas, concerning the definitions of criminal offences and sanctions or facilitating cross-border cooperation. However, in the field of asset confiscation, the EU authorities seem to go beyond these competences in their legislative activity. In this paper the author refers to this and other problems of EU legislation in criminal matters: covering up the insufficient competence to legislate with the argument of needing harmonisation, the lack of reliable data that would justify EU legislative activity and the problematic concept of effectiveness in EU legislation.
PKR activation-induced mitochondrial dysfunction in HIV-transgenic mice with nephropathy
Authors: Yoshida Teruhiko , Latt Khun Zaw , Rosenberg Avi Z , Santo Briana A , Myakala Komuraiah , Ishimoto Yu , Zhao Yongmei , Shrivastav Shashi , Jones Bryce A , Yang Xiaoping , Wang Xiaoxin X , Tutino Vincent M , Sarder Pinaki , Levi Moshe , Okamoto Koji , Winkler Cheryl A , Kopp Jeffrey B
Published: July 2024

HIV disease remains prevalent in the USA and chronic kidney disease remains a major cause of morbidity in HIV-1-positive patients. Host double-stranded RNA (dsRNA)-activated protein kinase (PKR) is a sensor for viral dsRNA, including HIV-1. We show that PKR inhibition by compound C16 ameliorates the HIV-associated nephropathy (HIVAN) kidney phenotype in the Tg26 transgenic mouse model, with reversal of mitochondrial dysfunction. Combined analysis of single-nucleus RNA-seq and bulk RNA-seq data revealed that oxidative phosphorylation was one of the most downregulated pathways and identified signal transducer and activator of transcription (STAT3) as a potential mediating factor. We identified in Tg26 mice a novel proximal tubular cell cluster enriched in mitochondrial transcripts. Podocytes showed high levels of HIV-1 gene expression and dysregulation of cytoskeleton-related genes; and these cells dedifferentiated. In injured proximal tubules, cell-cell interaction analysis indicated activation of the profibrogenic PKR-STAT3-platelet derived growth factor (PDGF)-D pathway. These findings suggest that PKR inhibition and mitochondrial rescue are potential novel therapeutic approaches for HIVAN.
Distinguishing mutants that resist drugs via different mechanisms by examining fitness tradeoffs
Authors: Schmidlin Kara , Apodaca Sam , Newell Daphne , Sastokas Alexander , Kinsler Grant , Geiler-Samerotte Kerry
Published: July 2024

There is growing interest in designing multidrug therapies that leverage tradeoffs to combat resistance. Tradeoffs are common in evolution and occur when, for example, resistance to one drug results in sensitivity to another. Major questions remain about the extent to which tradeoffs are reliable, specifically, whether the mutants that provide resistance to a given drug all suffer similar tradeoffs. This question is difficult because the drug-resistant mutants observed in the clinic, and even those evolved in controlled laboratory settings, are often biased towards those that provide large fitness benefits. Thus, the mutations (and mechanisms) that provide drug resistance may be more diverse than current data suggests. Here, we perform evolution experiments utilizing lineage-tracking to capture a fuller spectrum of mutations that give yeast cells a fitness advantage in fluconazole, a common antifungal drug. We then quantify fitness tradeoffs for each of 774 evolved mutants across 12 environments, finding these mutants group into 6 classes with characteristically different tradeoffs. Their unique tradeoffs may imply that each group of mutants affects fitness through different underlying mechanisms. Some of the groupings we find are surprising. For example, we find some mutants that resist single drugs do not resist their combination, while others do. And some mutants to the same gene have different tradeoffs than others. These findings, on one hand, demonstrate the difficulty in relying on consistent or intuitive tradeoffs when designing multidrug treatments. On the other hand, by demonstrating that hundreds of adaptive mutations can be reduced to a few groups with characteristic tradeoffs, our findings may yet empower multidrug strategies that leverage tradeoffs to combat resistance. More generally speaking, by grouping mutants that likely affect fitness through similar underlying mechanisms, our work guides efforts to map the phenotypic effects of mutation.
Mechanical force of uterine occupation enables large vesicle extrusion from proteostressed maternal neurons
Authors: Wang Guoqiang , Guasp Ryan , Salam Sangeena , Chuang Edward , Morera Andrés , Smart Anna J , Jimenez David , Shekhar Sahana , Friedman Emily , Melentijevic Ilija , Nguyen Ken C , Hall David H , Grant Barth D , Driscoll Monica
Published: July 2024

Large vesicle extrusion from neurons may contribute to spreading pathogenic protein aggregates and promoting inflammatory responses, two mechanisms leading to neurodegenerative disease. Factors that regulate extrusion of large vesicles, such as exophers produced by proteostressed
C. elegans
touch neurons, are poorly understood. Here we document that mechanical force can significantly potentiate exopher extrusion from proteostressed neurons. Exopher production from the
C. elegans
ALMR neuron peaks at adult day 2 or 3, coinciding with the
C. elegans
reproductive peak. Genetic disruption of
C. elegans
germline, sperm, oocytes, or egg/early embryo production can strongly suppress exopher extrusion from the ALMR neurons during the peak period. Conversely, restoring egg production at the late reproductive phase through mating with males or inducing egg retention via genetic interventions that block egg-laying can strongly increase ALMR exopher production. Overall, genetic interventions that promote ALMR exopher production are associated with expanded uterus lengths and genetic interventions that suppress ALMR exopher production are associated with shorter uterus lengths. In addition to the impact of fertilized eggs, ALMR exopher production can be enhanced by filling the uterus with oocytes, dead eggs, or even fluid, supporting that distention consequences, rather than the presence of fertilized eggs, constitute the exopher-inducing stimulus. We conclude that the mechanical force of uterine occupation potentiates exopher extrusion from proximal proteostressed maternal neurons. Our observations draw attention to the potential importance of mechanical signaling in extracellular vesicle production and in aggregate spreading mechanisms, making a case for enhanced attention to mechanobiology in neurodegenerative disease.
A toolbox for genetic targeting of the claustrum
Authors: Tuberosa Joël , Boillat Madlaina , Dal Col Julien , Marconi Leonardo , Codourey Julien , Mannino Loris , Georgiou Elena , Menoud Marc , Carleton Alan , Rodriguez Ivan
Published: July 2024

The claustrum (CLA), a subcortical nucleus in mammals, essentially composed of excitatory projection neurons and known for its extensive connections with the neocortex, has recently been associated with a variety of functions ranging from consciousness to impulse control. However, research on the CLA has been challenging due to difficulties in specifically and comprehensively targeting its neuronal populations. In various cases, this limitation has led to inconsistent findings and a lack of reliable data. In the present work, we describe the expression profile of the
Smim32
gene, which is almost exclusively transcribed in excitatory neurons of the CLA and the endopiriform nucleus, as well as in inhibitory neurons of the thalamic reticular nucleus. Leveraging this unique expression pattern, we developed a series of Cre- and Flippase-expressing knockin and BAC transgenic mouse lines with different expression profiles. With these novel tools in hand, we propose new standards for the interrogation of CLA function.
The integrated WF-Haldane (WFH) model of genetic drift resolving the many paradoxes of molecular evolution
Authors: Ruan Yongsen , Wang Xiaopei , Hou Mei , Diao Wenjie , Tracy Miles E , Xu Shuhua , Liufu Zhongqi , Wen Haijun , Wu Chung-I
Published: July 2024

Genetic drift, the random changes in frequencies of neutral variants, is the fundamental force of molecular evolution. Under-estimation of genetic drift is a major cause of mis-conclusions on evolution. However, the standard Wright-Fisher (WF) model of random sampling in population of size
N
only partially defines genetic drift with 1/
N
or 1/
N

e

(
N

e

being a function of varying
N
’s). In parallel, JBS Haldane proposed the branching process for genetic drift (Haldane 1927), whereby each gene copy is transmitted to
K
descendants with the mean and variance of
E
(
K
) and
V
(
K
). Genetic drift in its essence is
V
(
K
), i.e., the variance in transmission success, or
V
(
K
)/
N
when averaged over the population. Under the general WF models (i.e., the standard model as well as the many modifications), paradoxes have emerged. They include: i) Most curiously, genetic drift may often become stronger as
N
becomes larger at the ecological time scale, opposite to the model; ii) Sex chromosomes experience drift differently even with the same normalized
N
; iii) Genetic drift operates on advantageous mutations depends on
V
(
K
) but not on
N
; iv) Irresolution and paradoxes emerge in multi-copy gene systems, including diploidy, viruses and others, whereby evolution progresses both within and between individuals (Wang, et al. 2024). We now show that the integration of the WF and Haldane (i.e., WFH) model can resolve these paradoxes. Most important, the WFH model can fully define genetic drift in molecular evolution.
The integrated WF-Haldane (WFH) model of genetic drift resolving the many paradoxes of molecular evolution
Authors: Ruan Yongsen , Wang Xiaopei , Hou Mei , Diao Wenjie , Tracy Miles , Xu Shuhua , Wen Haijun , Wu Chung-I
Published: July 2024

Genetic drift, the random changes in frequencies of neutral variants, is the fundamental force of molecular evolution. Under-estimation of genetic drift is a major cause of mis-conclusions on evolution. However, the standard Wright-Fisher (WF) model of random sampling in population of size
N
only partially defines genetic drift with 1/
N
or 1/
N

e

(
N

e

being a function of varying
N
’s). In parallel, JBS Haldane proposed the branching process for genetic drift (Haldane 1927), whereby each gene copy is transmitted to
K
descendants with the mean and variance of
E
(
K
) and
V
(
K
). Genetic drift is simply
V
(
K
), i.e., the variance in transmission success, or
V
(
K
)/
N
when averaged over the population. Under the WF model, many paradoxes have emerged: i) Most curiously, genetic drift may often become stronger as
N
becomes larger at the ecological time scale, opposite to the model; ii) Sex chromosomes experience drift differently even with the same normalized
N
; iii) Genetic drift operates on advantageous mutations depends on
V
(
K
) but not on
N
. iv) Irresolution and paradoxes emerge in multi-copy gene systems, including diploidy, viruses and others, whereby evolution progresses both within and between individuals. We now show that the integration of the WF and Haldane (i.e., WFH) model can resolve these paradoxes. Most important, the WFH model can fully define genetic drift in molecular evolution.