bluuebunny/crossref_metadata_2025 huggingface dataset:
A new Asian leaf litter toad of the genus Leptobrachella (Amphibia, Anura, Megophryidae) from central south China
Authors: Liu Jing , Shi Shengchao , Li Shize , Zhang Mengfei , Xiang Sunjun , Wei Gang , Wang Bin
Published: February 2023

A new species of the Asian leaf litter toad genusLeptobrachellafrom central south China is described. Molecular phylogenetic analyses, based on mitochondrial 16S rRNA and nuclear RAG1 gene sequences indicated the new species as an independent clade in the genus. The new species could be distinguished from its congeners by a combination of the following characters: body of medium size (SVL 29.2–34.2 mm in 15 adult males and 34.4–43.1 mm in seven adult females); distinct black spots present on flanks; toes rudimentary webbed, with wide lateral fringes; ventral belly white with distinct nebulous brown speckling on ventrolateral flanks; skin on dorsum shagreened with fine tiny granules or short ridges; iris copper above, silver below; heels overlapped when thighs are positioned at right angles to the body; tibia-tarsal articulation reaches the middle eye; dorsal surface of tadpole semi-transparent light brown, spots on tail absent, keratodont row formula I: 3+3/2+2: I; call series basically consist of repeated long calls, at dominant frequency (5093 ± 412 Hz).
Taxonomic notes of subgenus Velia (Cesavelia) Koçak & Kemal, 2010 (Hemiptera, Heteroptera, Veliidae) from China, with description of one new species
Authors: Jin Zezhong , Fu Siying , Ye Zhen
Published: February 2023

Velia (Cesavelia) buisp. nov. from Hubei Province, China is described, and Velia (Cesavelia) tonkina Polhemus & Polhemus, 2003 is newly recorded from China. In addition, new distribution data for three species of Velia (Cesavelia), V. longiconnexiva Tran, Zettel & Buzzetti, 2009, V. sinensis Andersen, 1981 and V. tonkina Polhemus & Polhemus, 2003 are provided. Photographs of the habitus in dorsal and lateral views, metafemora of males, genitalic structures and habitats, along with a distribution map of this subgenus, are provided.
« Repousser les murs » en temps de pandémie : langage, tourisme et liberté
Authors: Wilson Adam
Published: February 2023

Le tourisme se mêle toujours à une recherche – et à une promesse – de liberté, promesse d’autant plus séduisante dans le contexte de la pandémie de covid-19. Cet article a pour but d’explorer la reprise d’activité touristique « post-confinement » en France d’un point de vue sociolinguistique afin d’interroger les manières dont des rapports se tissent entre tourisme et liberté à cette période particulière. Prenant appui sur un travail de terrain entrepris dans le cadre de deux destinations françaises particulièrement représentatives des transformations du tourisme liées à la crise sanitaire, la première partie de l’analyse met en avant la part langagière d’une demande et d’une offre touristiques centrées autour de la nature. Dans la deuxième partie de l’analyse, cette demande et cette offre sont mises en lien avec une recherche de liberté et avec sa (co-)construction, ce qui donne lieu à l’identification de libertés émergentes dans le tourisme, c’est-à-dire des expériences de liberté créées dans et par le discours. En guise de conclusion, une réflexion est proposée sur ce que ces analyses peuvent nous dire sur les relations entre tourisme et liberté, que ce soit pré-, per-, ou post-pandémie.
L’État en action dans Mondes en développement
Authors: Leloup Fabienne
Published: February 2023

En près de 200 numéros, quel traitement la revue Mondes en développement, consacrée aux modes et trajectoires de développement dans le monde, réserve-t-elle à l’étude de l’État, de l’action publique et du politique ? L’examen des dossiers thématiques et d’un échantillon d’articles permet de retracer les rôles, les défis et les enjeux posés par l’État au cours des dernières décennies. Cette analyse est introduite par le point de vue établi par la Banque mondiale dans ses rapports annuels et mise en perspective par des travaux de synthèse récents menés autour de l’action publique en Afrique et en Amérique latine. Classification JEL : H1, H7, R5
La gouvernance mondiale des États désunis
Authors: Plane Patrick
Published: February 2023

La gouvernance mondiale d’après 1945 s’est structurée autour des États-Unis. Les institutions spécialisées comme le FMI et la Banque mondiale sont régulièrement contestées pour la nature des programmes qu’elles instillent et pour la domination qu’y exercent les pays développés. Cette gouvernance mondiale s’essouffle. Les puissances émergentes, dont la Chine, marquent des revendications de leadership, critiquent par ailleurs le libéralisme politique et son rôle dans le développement. Ces positions, sur lesquelles s’alignent certains pays en développement, amènent à une question de fond : jusqu’où aller dans l’altération des valeurs de la démocratie tout en maintenant la prospérité collective dans le respect des droits individuels ? Classification JEL : F5, F53, P51, E02
Les victimes au centre. Reconnaissance, pardon, réconciliation
Authors: Guibert Vincent
Published: February 2023

Mettre les victimes au centre provoque l’Église à un long chemin d’écoute et de transformation. Son écoute des victimes doit être bienveillante tout en permettant à la personne concernée de sortir de sa culpabilité provoquée par le traumatisme. Les victimes sont devenues les témoins d’un immense drame pour le Corps de l’Église qui vit une étape historique. Un « marcher ensemble » de type synodal s’ouvre maintenant et il faut tout faire pour que ce chemin commun porte du fruit. Une Église traversée par la parole des victimes fait pénitence : elle ne peut plus être une institution préoccupée d’elle-même. La Parole de Dieu ouvre un chemin de réconciliation : elle est performative et permet de passer des étapes. Quel rite proposer aux victimes pour qu’elles deviennent des témoins au sens fort ?
Transformation par rupture ?
Authors: Zollner Hans
Published: February 2023

Une analyse des mentalités spécifiquement catholiques explique pourquoi l’Église ne parvient pas à se réformer pour faire face aux abus. La posture défensive en réaction à la perte de pouvoir de l’Église a renforcé l’affirmation de son infaillibilité et un sentiment de victimisation, aux dépens de l’écoute des critiques et renforçant le devoir de protéger l’institution. La gestion du pouvoir et de la sexualité n’est pas adéquatement prise en compte dans la formation des clercs. Il faut donc non seulement clarifier les procédures canoniques et les structures d’autorité, mais changer les mentalités : reconnaître ouvertement les crimes, susciter la collaboration de tous pour lutter contre le cléricalisme, mettre en place des mesures de protection contre les abus et contre les accusations injustes, et offrir des lieux de guérison.
“Mind the Gap” - An overview of the role of the Extensions Community Healthcare Outcomes (ECHO) model in enhancing value in health care delivery
Authors: Kenny Christina , Priyadarshini Anushree
Published: February 2023

The ECHO (Extensions Community Healthcare Outcomes) model of healthcare delivery has grown rapidly since its establishment and increased in popularity in recent years. This expansion has developed alongside the growing incidence of chronic diseases and the need to better manage them. The increasing uptake in ECHO has presented a requirement to assess its true value as healthcare costs are increasing globally, resulting in a growing demand by governments and policy makers to ensure chronic disease management strategies provide true value. Therefore, the aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated. A narrative literature review is carried out to examine the outcomes assessed in ECHO-related studies. Three key academic databases were utilised for the literature search: Web of Science, PubMed, and Medline. Keywords relating to the review were chosen and searched for. Papers were screened using specified inclusion and exclusion criteria relating to years of publication (2000–2020), type of publication (original research, review papers and meta-analyses) and language requirements (English language only). This review found that while the ECHO model is expanding, and improving the so-called “knowledge gap” between specialists and primary care physicians, there is also a gap in the ways value is examined within ECHO. Most studies on ECHO lack an examination of patient reported health outcomes and appropriate, comparative costing methods. Current ECHO-related studies lack vital components that demonstrate the value of the model. Such components include patient reported health outcomes and detailed costing comparisons between the ECHO model and the traditional care pathway it is replacing.
Evaluating and Measuring Exactly the Distances between Aggregate Health Performances: A Global Health Data and Welfare Regime Analysis
Authors: Aspalter Christian
Published: February 2023

This paper presents the results of a global data analysis that for the first time ever looks at the exact performance distances when combining groups of quantitative health and health care indicators that stand for performance differences between the health care system performances of different countries in every corner of the world. Thus, by using Aspalter’s new Standardized Relative Performance Index, we can now not just rank all health care systems and health policy outcomes (as before) but can also, which is entirely new, measure them exactly and compare them exactly with one to another and/or different groups of indicators (dimensions) thereof. The World Health Organization, the Organization of Economic Corporation and Development, and the World Bank have yet to use such an indicator (Aspalter’s Index) that is able to add up and directly compare different variables, groups of variables among each other, and, of course, for example, different groups of countries among each other, while adding to the quality and quantity of overall information and knowledge gathered on the research subject(s) in the case of quantitative data analysis. For a more in-depth analytical purpose, the “Ten Worlds of Welfare Regime Theory” (or “ten worlds theory” in short) has been used to arrive at further conclusions and extra valuable information and knowledge on top of the rich comparative data analysis conducted in this study.
Alfonso el Sabio y su philobiblon atesorado
Authors: Pichel Ricardo
Published: February 2023

El patrimonio cultural que nos legó Alfonso X es inabarcable en los diferentes campos del saber que promovió durante su reinado. El renacimiento y renovación cultural de lo que sus propios colaboradores denominaron «era alfonsí» transcendió las coordenadas geográficas y temporales de su audiencia cortesana, generando e inspirando nuevas tradiciones textuales. Los trabajos integrados en este volumen monográfico se centran en tres de las grandes áreas de interés para el Rey Sabio: la literatura devocional y miraculística –representada por las Cantigas de Santa María–, la historiografía general o universal –en este caso, ejemplificada en la General estoria– y, por último, la literatura jurídica –en particular, las Siete Partidas y el Setenario–. Todos ellos contribuyen a avanzar en el conocimiento del denso entramado de relaciones culturales desplegado por el Rey Sabio en las obras que promovió y en su evolución ideológica a lo largo de su complejo periplo político.
Alfonso X’s General Estoria at the dawn of Portuguese Renaissance. Study and transcription of a late fifteenth century fragment
Authors: Leite Mariana
Published: February 2023

The existence of a Portuguese version of the General Estoria, probably produced around the late-xivth and early-xvth centuries, has been known through very few short and damaged fragments, found throughout the xxth century. The most recently found is a five-folio witness from the late-xvth/ early-xvith centuries preserved in the Arquivo Nacional da Torre do Tombo, Lisbon. In this article, I present a first transcription of this fragment. The linguistic elements of this Portuguese translation are considered, as well as the proximity or distance between the translation and its source. The main purpose of this paper is to make the text of the fragment available to the public and thus continue the research on the circulation of this major Alfonso X's work in Portugal.
Lector in ffabla: Estructuras del Setenario de Alfonso X el Sabio (II)
Authors: Puigdengolas Johan
Published: February 2023

En la segunda parte de esta serie de estudios, propondremos un foco en la complementariedad entre trama formular y trama narrativa en el Setenario de Alfonso X el Sabio para determinar las especificidades de esta codificación única e inédita del discurso jurídico alfonsí.
Intraoperative hydrodissection and Doppler ultrasound during magniﬁed varicocelectomy: A comparative study
Authors: Shebl Salah E. , Ali Saadelddin , El Gammal Ahmed
Published: February 2023

Methods: We performed a non-randomized comparative trial that recruited infertile men with varicocele who were scheduled to undergo MSV. Eligible patients were allocated by the investigators in a 1:1 ratio to receive intraoperative Doppler (group I) or intraoperative Doppler plus hydrodissection (group II). Results: Sixty men were included in each group. The two study groups showed a comparable number of ligated veins on the right (4.22 ±1.57 versus 4.42 ± 1.65; p = 0.49) and left side (6.77 ± 2.14 versus 6.98 ± 2.29; p = 0.59). On the contrary, group II showed a signiﬁcantly higher number of preserved arteries on the right (2.42 ± 0.56 versus 1.47 ±0.5 in group I) and left side (2.6 ± 0.53 versus 1.63 ± 0.55 in group I), with p-value < 0.001. The sperm motility was signiﬁcantly higher in group II than in group I (21.25 ± 13.73 versus 13.85 ± 12.25, respectively; p = 0.002). In both groups, the sperm motility increased signiﬁcantly at the end of follow-up compared to the preoperative period. The postoperative sperm mortality remained signiﬁcantly higher in group II than in group I(p = 0.008).Conclusions: Intraoperative Doppler plus hydrodissection (D+IH-MSV) has advantages in preserving more arteries and enhancing the motility of sperms. Based on these ﬁndings, we strongly recommend D+IH-MSV when treating infertile men with varicocele.
‘People don’t understand what we go through!’: Caregiver views on South Africa’s care dependency grant
Authors: Trafford Zara
Published: February 2023

Background: Caregivers are under enormous pressure in trying to provide for the needs of their children with disabilities in South Africa. The care dependency grant (CDG), an unconditional cash transfer, is the primary state-subsidised intervention for the social protection of low-income caregivers of children with disabilities.Objectives: The primary objective of this substudy, within a larger multistakeholder qualitative project, was to investigate caregiver perspectives on CDG assessment and application, their beliefs about the purpose of the CDG and how they actually used these funds.Methods: Data for this qualitative research included in-depth individual interviews and one focus group discussion. Six low-income caregivers who were current or previous CDG beneficiaries participated. Deductive thematic analysis was conducted using codes related to the objectives.Results: Access to the CDG was usually too late and over-complicated. Caregivers were grateful for the CDG but it was insufficient to cover the costs of care, in the context of high unemployment and weaknesses in complementary social services. Pressure on these caregivers was intensified by criticism in their social environments and a lack of respite care.Conclusion: Caregivers need service providers to be better trained and for systems of referral to available social services to be strengthened. The whole of society ought also to be targeted for increased social inclusion facilitated by improvements in understandings of the lived experience and cost of disability.Contribution: The rapid time from data collection to write-up of this study will aid in building the evidence base on the CDG, an urgent priority for South Africa’s journey towards comprehensive social protection.
Challenges in the working relationship between professional nurses and clinical associates in selected district hospitals in South Africa
Authors: Mokoena Emmah M. , Rabie Tinda , Du Preez Antoinette
Published: February 2023

Background: Clinical associates were introduced in South Africa to address physician shortages in healthcare. Professional relationships between physicians and professional nurses (PNs) have been widely researched, but none specifically between the new cadre of clinical associates and PNs.Aim: This study aimed to understand the professional working relationship between PNs and clinical associates.Setting: Selected district hospitals within Mpumalanga Province, South Africa.Method: A qualitative descriptive design was used. Professional nurses were purposely sampled, and an all-inclusive sampling method was used for clinical associates in selected district hospitals within Mpumalanga Province, South Africa. Twelve (N = 12) semi-structured, individual interviews (PNs n = 6; clinical associates n = 6) guided by an interview guide were conducted in English. The interviews were audio recorded and transcribed verbatim by an independent transcriptionist. Tesch’s eight steps of data analysis were employed to analyse the data. An independent co-coder assisted with data analysis.Results: This study yielded four themes: (1) professional relationship defined, (2) professional relationship characteristics, (3) professional challenges applicable to both PNs and clinical associates and (4) personal professional challenges applicable to clinical associates only.Conclusion: This study demonstrated that the professional relationships between PNs and clinical associates are affected by various challenges, which could be resolved within the department through in-service training and good communication.Contribution: This is one of the first studies that highlight the professional relationship challenges between PNs and clinical associates.
Sabbath and Sunday: The meaning of the day of rest in the ancient church – A hope for the future?
Authors: Vaida Cristian
Published: February 2023

The Sabbath is part of Jewish tradition. In Christianity it has taken on a new meaning. Both faiths saw it as a gift from God, a tool to affirm one’s spiritual creed and identity, and a way to maintain a distinct faith identity. The secularism of contemporary society has resulted in a misinterpretation of the purpose of Sunday rest and a disregard for the spiritual aspects that the Sunday celebration involves. A false perception of Sunday rest has emerged in modern times: It is not perceived as a divine gift that enables a spiritual ministry, which leads to resistance and opposition to the restless anxiety of the consumerist world and serves as an alternative to advertising’s demanding presence in this world. This rest, as a gift from God, has been one of the most fundamental defining features of man’s connection with God throughout history. Since Christian antiquity, there has been substantial debate over how to observe this tremendous gift of rest. Rest was valued as a gift in the Jewish culture in a specific way that included defining the identity of the chosen people. Later, in the Christian tradition, it was connected to the celebration of Christ’s Resurrection and the spiritual healing He provided to the world. There has been much debate on the continuity and discontinuity between the Jewish Sabbath and the Christian Sunday, as well as on how the transition from the Sabbath to the Sunday celebration came about. The two qualities of the Jewish Sabbath – a day of rest and a day of religious celebration – have been transferred to the Christian Sunday but in a radically different context.Contribution: By analysing early Christian literature, this study aims to investigate how the concept of Sabbath rest was taken up and reconstructed in Christianity in the celebration of Sunday, and how spiritual work was a constant in the life of Christian communities up until the 4th century, when Sunday rest was established by law. Contrary to Rordorf’s opinions, this article aims to show that Christians, despite being physically obligated to work on Sundays, tacitly observed this day as a day of resurrection, emphasising the spiritual work of the virtues as their vehicle towards their entrance into the rest in God, even before Sunday became socially established as a day of rest (Heb 4:1–11). This study intends to show that this unique vision of the Sunday rest of the early church can be an element of resistance and an alternative to the demanding stress and restless anxiety of modern society.
Disaster risk index on disaster management budgeting: Indonesia’s national data set
Authors: Haris Nurhayati , Furqan Andi C. , Kahar Abdul , Karim Fikry
Published: February 2023

This study analysed Indonesian local government budgeting model based on the Disaster Risk Index (DRI). This study used a sample of local governments in Indonesia consisting of provincial, regency and municipality levels, especially for 2015–2019 data with a final sample of 2609 observations. The results of the analysis and testing showed that most of the Indonesian local governments fall into the high category in the DRI. The DRI has a positive effect on the Disaster Response Emergency Fund (DREF). The results were robust to the differences in DRI measurements, both using scores and DRI categories. This study also found that the DRI has been used as the basis for budgeting regional expenditures. The budget was allocated in disaster-related public procurements such as public service, housing, public facilities and public health. The budgeting for the implementation of economic and social functions was not influenced by the DRI. Instead, the DRI was found to have a negative effect on the implementation of environmental functions. The findings showed that in general, DRI has been used as the basis for budgeting for regional disaster management, but it is still limited to functions related to disaster emergency response. The budgeting of functions related to the prevention stage has not been optimally carried out, especially by mitigating natural hazards through strengthening the quality of the environment.Contribution: The results are expected to contribute to the local government to improve disaster resilience through strengthening regional financial funding.
Sustainability elements of companies that are affected by pandemics
Authors: Moolman Anneke M. , Fouché Jaco P. , Leendertz Verona
Published: February 2023

Orientation: The havoc created by COVID-19 reaffirmed the pervasive effects of pandemics on companies’ sustainability, which has become an increasingly important consideration for stakeholders.Research purpose: This study determined the sustainability elements of companies that are affected by pandemics.Motivation for the study: Pandemics’ recurring nature is evidenced by history. Knowledge of pandemics’ effects on sustainability may assist companies in preparing for and reporting on pandemics, while such information to stakeholders may be important when considering a company’s sustainability.Research design and method: The study followed a systematic review. The final sample constituted 30 records, which were thematically analysed.Main findings: A list of sustainability elements of companies that are affected by pandemics is provided. Government-imposed restrictions led to supply and demand shocks, severely threatening companies’ financial performance and socio-economic targets. Pandemics also present opportunities to improve business models by increasing focus on relationships, nature and digitalisation.Practical implications: This study may assist companies to minimise the effects of future pandemics on sustainability by urging them to recognise the interplay between sustainability’s components. Companies should have some financial leeway and consider the composition of its product/service range (essential versus non-essential) and the delivery thereof (traditional vs. e-commerce), consider and reduce its impact on nature, become more human-centric and finally, revisit their strategy through strong governance.Contribution: Current literature describes some effects of a single pandemic on companies within a specific industry, whereas this study’s scope is broadened to consider all pandemics and industries to derive an extensive list of affected sustainability elements. Current sustainability frameworks do not specify pandemic-related disclosure requirements, making the list useful as a reporting guideline.
Caregivers’ health-seeking behaviour for children participating in an integrated school health programme in KwaZulu-Natal, South Africa
Authors: Babatunde Gbotemi B. , Akintola Olagoke
Published: February 2023

Background: Caregivers are active members of the healthcare team, and the uniqueness of their role in caring for a sick child is holistic, as no other healthcare team member is consistently aware of all the facets of the child’s life. The integrated school health programme (ISHP) aims to improve access to healthcare services and promote equity for school-going children by delivering comprehensive healthcare services. However, not much attention has been paid to understanding caregivers’ health-seeking experiences within the context of the ISHP.Aim: This study sought to understand caregivers’ health-seeking behaviour for their children participating in the ISHP.Setting: Three low-resource communities were chosen within the eThekwini District of the KwaZulu-Natal province, South Africa.Methods: This study utilised a qualitative research design. We recruited 17 caregivers using purposive sampling. Semistructured interviews were conducted, and the data were analysed using thematic analysis.Results: Caregivers explored multiple means of care, ranging from managing the children’s health conditions based on previous experiences to visiting traditional healers and administering traditional medicines. Caregivers delayed health seeking due to low literacy levels and financial barriers.Conclusion: Although ISHP has expanded its coverage and the range of services provided, the study suggests the need to implement interventions focused on providing support to caregivers of sick children within the ISHP context.Contribution: The findings of the study highlight the need to develop potential schemes to address transportation barriers to accessing healthcare services for school-going children.
Alexis O-ring wound retractor versus traditional metal retractors for the prevention of postcaesarean surgical site infections
Authors: Mothiba Marabe S. , Tshepuwane Tshimane C. , Adefolalu Adegoke O. , Monokoane Tshweu S.
Published: February 2023

Background: Postcaesarean surgical site infections (SSI) remain a burden globally. The Alexis® O C-Section Retractor, a plastic sheath retractor known to have decreased incidence of SSIs in gastrointestinal surgery, is yet to have its efficacy established during caesarean section (CS). This study aimed to compare the differences in the rate of postcaesarean surgical wound site infections between the Alexis® retractor and traditional metal retractors during CS at a large tertiary hospital in Pretoria.Methods: Pregnant women scheduled for elective CS were prospectively randomised to either the Alexis® retractor group or the traditional metal retractor group at a tertiary hospital in Pretoria between August 2015 and July 2016. The defined primary outcome was development of SSI, and secondary outcomes comprised patients’ peri-operative parameters. All participants’ wound sites were observed in the hospital for 3 days before discharge and again at 30 days postpartum. Data were analysed using SPSS version 25 with p  0.05 considered significant.Results: A total of 207 participants were involved, Alexis® (n = 102) and metal retractors (n = 105). None of the participants developed postsurgical site wound infection after 30 days, and there were no differences in time to delivery, total operative time, estimated blood loss or postoperative pain between the two arms of study.Conclusion: The study found no difference in participants’ outcomes using the Alexis® retractor in comparison with the traditional metal wound retractors. We suggest that the use of Alexis® retractor be at the surgeon’s discretion and its routine use not advised for now.Contribution: This research being the first of its kind in South Africa in which patients’ clinical outcomes were compared post caesarean section from Alexis’s plastic sheath group and metal retractors group in an attempt to proffer solution to the high burden of SSI. Although no difference was seen at this point, the research was pragmatic, as it was carried out in a setting with high burden of SSI. The study is going to serve as a baseline against which studies carried out in future can be compared.
One World, One Health: A growing need for an integrated global health approach
Authors: Kaswa Ramprakash , Von Pressentin Klaus , Nair Arun , Murphy Shane
Published: February 2023

No abstract available.
Assessment of Pulmonary Hypertension in Chronic Kidney Disease Patients using Doppler Echocardiography
Authors: Gaur Jyoti , Singh Rakesh Kumar , Kulkarni Chaitanya , Dube Simmi
Published: February 2023

Background:

The incidence of chronic kidney disease (CKD) is increasing globally and is associated with significant morbidity and mortality related to the cardiovascular system. There is limited data on pulmonary hypertension (PH) in CKD patients, especially from developing and underdeveloped countries. PH leads to hypoxia which is a significant cause of dyspnea in CKD patients with or without pulmonary edema. Hence, we planned this study to assess the PH in CKD patients using two-dimensional (2D) color Doppler echocardiography.

Materials and Methods:

This is an observational cross-sectional study. A total of 100 CKD patients on hemodialysis or conservative management were enrolled in the study. Following the collection of demographic data, and routine/specific investigations, these patients were assessed for PH using 2D color Doppler echocardiography.

Results:

PH was found in 47% of patients with CKD. Left ventricular (LV) hypertrophy, systolic and diastolic dysfunction, dilated right atrium/right ventricular and left atrial/LV chambers, and valvular hypertrophy were other echocardiography findings recorded in these patients. Low hemoglobin levels, high urea/creatinine levels, and duration of hemodialysis in CKD patients were found to be significantly associated with the presence of PH.

Conclusion:

The majority of CKD patients have PH at various stages of disease-causing unexplained dyspnea in these patients. PH is common in end-stage CKD as compared to patients with a less severe stage of CKD. Hence, CKD patients should be evaluated for PH, especially in the presence of intractable dyspnea.
Beta-Blockers in the Prevention and Treatment of Ischemic Heart Disease
Authors: Khan Omer , Patel Murti , Tomdio Anna N. , Beall Jeffrey , Jovin Ion S.
Published: February 2023

Coronary artery disease (CAD) is the most prevalent cardiovascular disease characterized by atherosclerotic plaque buildup that can lead to partial or full obstruction of blood flow in the coronary arteries. Treatment for CAD involves a combination of lifestyle changes, pharmacologic therapy, and modern revascularization procedures. Beta-adrenoceptor antagonists (or beta-blockers) have been widely used for decades as a key therapy for CAD. In this review, prior studies are examined to better understand beta-adrenoceptor antagonist use in patients with acute coronary syndrome, stable coronary heart disease, and in the perioperative setting. The evidence for the benefit of beta-blocker therapy is well established for patients with acute myocardial infarction, but it diminishes as the time from the index cardiac event elapses. The evidence for benefit in the perioperative setting is not strong.
Myocardial Bridging in Cases of Sudden Death and its Association with Clinicopathologic Characteristics
Authors: Sylvia Mary Theresa , Soundharia R , Bhat Ramachandra V. , Marak Fremingston
Published: February 2023

Background:

Myocardial bridging (MB) is the course of the epicardial segment of a coronary artery within the myocardium. The systolic compression of this segment called the tunneled segment may lead to alterations in blood flow to the heart. We have studied the gross and microscopic features of MB in cases of sudden cardiac death and analyzed its characteristics and whether there is any association with other clinicopathological characteristics which may help us to understand the pathogenesis and risk stratification.

Materials and Methods:

This is a retrospective descriptive study of 132 postmortem heart specimens of sudden cardiac death. The coronary arteries were dissected, and MB and its characteristics were studied. Statistical analysis was performed using the Chi-square and Fisher's exact tests (P < 0.05 significant).

Results:

MB was present in 28 cases (21.2%), with a mean age of 49.5 years and male:female ratio of 27:1. MB was seen in the left anterior descending artery in 86.2% of cases, the right coronary artery in 10%, and left circumflex artery in 3.5% of cases. Atherosclerosis was seen in the segment proximal to the tunneling in 89.2% of cases leading to infarction in four cases. Left ventricular hypertrophy (LVH) was significantly associated with MB cases (19/68%) (P < 0.05).

Conclusion:

MB causes turbulence of blood in the proximal segment leading to coronary atherosclerosis, thereby predisposing the heart to ischemic changes and LVH and may lead to infarction in a few cases.
Managing Calcified Coronaries
Authors: Dash Debabrata , Reddy Sreenivas
Published: February 2023

Percutaneous coronary intervention of lesions with heavily coronary artery calcium (CAC) still is a challenging subset for interventionists, with incremented risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. With the emergence of many novel devices and technologies, the treatment of such lesions has become increasingly feasible, safe, and predictable. It seems likely that combining enhanced intravascular imaging modalities with conventional or new dedicated tools for the treatment of CAC grants better lesion preparation. This optimizes delivery and deployment of drug-eluting stents translating into improved patient outcomes. In this focused review, we provide a summary of principles, techniques, and contemporary evidence for sundry subsisting and emergent plaque-modifying strategies.
Left Ventricular Global Longitudinal Strain by Speckle Tracking Echocardiography as a Noninvasive Predictor in Evaluation of Myocardial Infarction
Authors: Kumar K. P. , Piedade Joel Quadros , Malali Venkatesh , Hegde Srinidhi
Published: February 2023

Background:

Coronary artery disease (CAD) has assumed epidemic proportions in the world. Accurate risk stratification and early invasive management when indicated can reduce morbidity and mortality substantially. The study aims to correlate left ventricular (LV) function assessed by global longitudinal strain (GLS) with the extent of CAD in patients with myocardial infarction (MI).

Methods:

The study was conducted in a tertiary care hospital in Southern India. A total of 105 patients admitted with a diagnosis of non ST-elevation MI were included. All patients had a detailed echocardiogram with the evaluation of LV GLS by two-dimensional speckle tracking echocardiography and ejection fraction by Simpson's method. Coronary angiogram was also done in all patients to study the coronary anatomy and the relation between CAD and LV GLS.

Results:

The mean age of study population was 53.9 years. Echocardiographic study revealed mean LV ejection fraction (LVEF) was 48.16 + 12.27. The mean LVEF in patients with single-vessel disease was 50.11 + 11.62; with two-vessel disease, it was 51.81 + 10.34, and in patients with triple-vessel disease, it was 41.5 + 11.8. The mean GLS in the abovementioned groups was − 15.6 + 3.33, −13.5 + 3.2, and − 11.02 + 4.14, respectively. The follow-up of patients also showed a considerably lower GLS in patients who suffered higher morbidity and mortality.

Conclusion:

LV GLS is a good noninvasive predictor of the burden of CAD on the angiogram and also a predictor of future cardiovascular events and mortality.
Understanding the Status of the Egyptian Coronary Lesions
Authors: El-Dosouky Ibtesam Ibrahim , Nashy Baher Nabil , Abomandour Hala Gouda
Published: February 2023

Background:

High-probability zones of coronary thrombosis may exist along the coronary tree. We aimed to determine the nature and distribution of significant coronary lesions among our patients.

Methods:

This study included 529 patients, for whom coronary angiography was done for suspected or proved coronary artery disease (CAD), they were divided into three groups according to the distribution of the coronary lesions: left anterior descending (LAD) group (n = 305) with significant LAD lesion, left circumflex (LCx) group (n = 148) with significant LCx lesion and right coronary artery (RCA) group (n = 181) with significant RCA lesion.

Results:

One hundred and sixty-nine (31.9%) had nonsignificant lesion, 166 (31.4%) had single-vessel disease, with significantly higher incidence of significant LAD lesion 305 (57.5%) which were proximal 52.4%, LAD lesions were more prone to be the culprit vessel 47.5%, LCx was the least vessel with significant lesion 148 (27.9%), and the least to be prone as a culprit 21.1%. Proximal culprit LAD 63.5% and RCA 55.6% had significantly higher incidence, mid culprit LC× 53.9% had significantly higher incidence. ST-elevation acute coronary syndrome (STE-ACS) was significantly more prevalent in culprit LAD 76.7%. Non-STE-ACS was significantly more prevalent in culprit LC× 56.5% and RCA 55.6%.

Conclusion:

LAD tends to carry more than one culprit lesion, more to be proximal. Risk factors responsible for instability and sheer stress (uncontrolled diabetes mellitus, uncontrolled hypertension, heavy smoking) were more prevalent between patients with LCx as a culprit followed by RCA in Egyptian; this may throw the light on the need for aggressive control of these risk factors to reduce vulnerability in these patients.
Mitral Annular Calcification Leading to Severe Mitral Stenosis in a Patient with Severe Calcific Aortic Stenosis and Complete Heart Block
Authors: Sofi Najeeb Ullah , Sinha Santosh Kumar , Sachan Mohit
Published: February 2023

Calcium deposition in the heart can present in various ways. Mitral annular calcification (MAC) can cause mitral regurgitation but severe mitral stenosis has been reported very rarely. Mitral stenosis in the Indian subcontinent is mostly caused by rheumatic heart disease; however, here, we present a case of severe mitral stenosis due to MAC in a hypertensive and diabetic female that also had severe calcific aortic stenosis and conduction defect. Clinicians need to be aware of other causes of acquired mitral stenosis that include systemic lupus erythematosus, antiphospholipid antibody syndrome, carcinoid syndrome, mucopolysaccharidosis, Whipple disease, radiation, and MAC. Although MAC usually causes mitral regurgitation, severe mitral stenosis has been reported very rarely. However, when MAC is the cause of severe mitral stenosis, those patients are poor candidates for mitral valve replacement. Differentiating the etiology of mitral stenosis is of therapeutic and prognostic significance.
A Case of Middle Aortic Syndrome in Takayasu Arteritis with Left Ventricle Dysfunction and Heart Failure
Authors: Thakkar Darshan P. , Shankar Sandeep , Soudri Ramnaresh , Babu Reddy T. S. , Nagesh C. M. , Srinivas B. C. , Manjunath C. N.
Published: February 2023

Left ventricular dysfunction is an uncommon complication of Takayasu arteritis (TA) with a prevalence of about 10%–15%. We report a case of a 27-year-old girl who presented with dyspnea, bipedal edema, loss of weight, and easy fatigability for 3 months. Patient also developed right hemiparesis 3 months ago. Computed tomography of the brain was suggestive of the left temporal infarct, on evaluation she was diagnosed as left ventricle (LV) dysfunction and she was treated for CVA and heart failure. Clinical examination revealed the absence of the left upper limb and bilateral lower limb pulses with right upper limb hypertension. Echocardiography revealed severe LV dysfunction (ejection function ~20%). Computed tomography angiogram and other inflammatory markers confirmed the diagnosis of TA and revealed the presence of coaraction of the thoracic and abdominal aorta. Coaractoplasty was done, and immunosuppressant therapy with oral prednisolone and weekly oral methotrexate was started. On follow-up, patient is asymptomatic with improved LV function. Any patient with LV dysfunction or dilated cardiomyopathy, reversible causes have to be ruled out and TA has to be thought of as a differential diagnosis particularly in young females. Checking of all four limbs pulses and blood pressure is strictly recommended. TA is a systemic vasculopathy that can progress to cause vital organ ischemia. Therefore, early diagnosis and management as well as long-term follow-up is recommended.
Qt-Dispersion and Major Adverse Cardiovascular Events Prediction After Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus
Authors: Wageeh Shaimaa , EL-Dosouky Ibtesam , ELShabrawy Arafa M. , Omar Rasha E H , Zein Shimaa G
Published: February 2023

Objectives:

The objective of this study investigated the relation between QT-dispersion (QTd) and both number of coronary artery disease and major adverse cardiovascular events (MACEs) among patients with type 2 diabetes after elective percutaneous coronary intervention (PCI).

Methods:

One hundred ischemic heart disease patients undergoing elective coronary angioplasty were included; 49 patients with diabetes (group I) and 51 patients without diabetes mellitus (group II). Based on the QTd parameter after PCI, both groups were subdivided into tertiles. Angiographic, electrocardiographic parameters, and MACE were compared.

Results:

Both QTd after PCI and delta QTd were correlated to the number of diseased coronary arteries and MACE in patients with diabetes compared to patients without diabetes. QTd was longer in patients with diabetes developing MACE than those without MACE (r = −0.31, P = 0.04).

Conclusion:

QTd after PCI and delta QTd are the independent predictors of MACE in patients with type 2 diabetes.
Incidence, Management Patterns, and Outcomes of Cardiovascular Implantable Electronic Device-Related Infection – A Retrospective Registry-Based Analysis
Authors: Goel Pravin K. , Rajput Paritosh , Sahu Ankit Kumar , Khanna Roopali , Garg Naveen , Tewari Satyendra , Kumar Sudeep , Kapoor Aditya
Published: February 2023

Introduction:

Cardiovascular implantable electronic device (CIED) infection contributes to a significant clinical and financial burden. We sought to assess CIED postimplant infection rates and the effect of different treatment modalities on reinfection over a long-term follow-up.

Methods:

We retrospectively analyzed CIED recipients presenting with complications during 2010–2019 at our center. Data related to the different management modalities used as per the discretion of treating physician, were collected and patients were followed up telephonically.

Results:

A total of 3394 patients underwent CIED implantation of which 122 (3.5%) patients developing complications were included in the study. Mean age of the patients was 66.4 ± 12.5 years. Single-chamber ventricular pacing (VVI), dual-chamber (DDD) pacing, and biventricular pacing were seen in 68 (56.2%), 51 (41%), and 3 (2.8%) patients, respectively. CIED infection was seen in 61 patients (1.8%). Strategies used for CIED infection management included: new device implantation on contralateral side (n = 34; 55.7%), old device repositioning on same side (n = 14; 22.8%), antibiotic therapy alone (n = 5; 8.5%), resterilized device implantation on contralateral side (n = 3; 4.9%), epicardial lead placement (n = 3; 4.9%), and permanent device removal (n = 2; 3.3%). The CIED reinfection rates for the above strategies were 2.9%, 71.4%, 80%, 100%, 0% and 0%, respectively.

Conclusion:

Multiple strategies are being used in real-world practice for the management of CIED infection. Previously advocated strategy of reimplanting resterilized CIED is associated with high recurrence rates. The best practice still remains to implant a new device on the contralateral side post extraction of infected hardware.
Newer Oral Anticoagulants in Venous Thromboembolism
Authors: Modi Sunil , Modi Ranjan
Published: February 2023

Venous thromboembolism (VTE) is an important medical condition for morbidity and mortality. Adequate anticoagulant treatment is necessary to reduce short- and long-term VTE related conditions. In the past low molecular weight heparin (LMWH) and Vitamin K antagonists (VKAs) have been the mainstay of anticoagulation therapy for VTE patients. The patients require frequent monitoring with INR to keep balance between effectiveness and safety in clinical practice. NOACs have been the main stay of treatment in conditions requiring effective anticoagulation. They may prove to do the same in VTE. This article analyses, the present literature on use of NOACs in VTE.
An Interesting Case of Unusual Cause of Refractory Ventricular Tachycardia in a Chronic Kidney Disease Patient
Authors: Tumkur Ashwin , Sudhakar G. , Goura Prakash
Published: February 2023

Refractory ventricular tachycardia (RVT) has been a life-threatening form of arrhythmias. There are many causes reported in literature that are found to trigger RVT. Here, we report a rare cause of RVT. A gentleman under maintenance hemodialysis since 1 year was emplaced with permacatheter since then. He presented with signs and symptoms of RVT, on evaluation, it was found that RVT was caused due to broken permacatheter fragment that was embolized into the right ventricle. It was successfully retrieved through snare loop as an emergency and the RVT was then reverted to normal rhythm. Therefore, in patients undergoing hemodialysis or under treatment with such access devices symptoms of chest pain, irregular heart rhythms or complications like retained catheter must be considered as a part of differential diagnosis, even when substantial time has elapsed after initial catheter access emplacement.
Impact of Low Early High-Density Lipoprotein Cholesterol on Inhospital Outcome and Short-Term Prognosis in Patients with Acute Coronary Syndrome
Authors: Elkholy Tarek E. , Saeed Ekram S. , Omar Mahmoud A. Abo , El-barbary Yasser H.
Published: February 2023

Background:

Acute coronary syndrome (ACS) is a cardiac emergency and constitutes a major burden globally. Association between serum lipid and ACS is established many years ago. Our study tried to have more information about the impact of high-density lipoprotein cholesterol (HDL-C) on inhospital outcome and short-term prognosis of patients with ACS.

Materials and Methods:

The study was a prospective comparative study. Clinical and chemical and interventional evaluation was done in hospital settings. A total number of 50 patients were included in the study and divided into two groups. Patients with low HDL-C level were in Group I and patients with normal HDL-C were in Group II.

Results:

Group I populations had more inhospital complications than Group II represented in acute heart failure (48% vs. 13%), cardiogenic shock (40% vs. 6%), complex coronary lesions (57% vs. 20%), and prolonged hospital stay (54% vs. 20%). A statistical significance was found regarding these variables (P < 0.05). Regarding the outcome after 1 month, it is observed that patients of Group I significantly experienced heart failure (59.38% vs. 21.43%) and worsening angina (62.5% vs. 28.57%) with a statistically significant difference. In contrast, there is no statistically significant difference regarding myocardial infarction, new cerebrovascular events, shock, and mortality.

Conclusion:

The study showed a strong association of HDL-C level with inhospital adverse events of ACS patients in addition to short-term adverse events. Complications of ACS were more in patients with low HDL-C level.