bluuebunny/crossref_metadata_2025 huggingface dataset:
14. REDUCE CARDIOMETABOLIC RISK BY REDUCING SITTING TIME AMONG OVERWEIGHT AND OBESE ADULTS: A META-ANALYSIS
Authors: Putra Andi Eka , Hendsun
Published: May 2021

Background:

Hypertension is a worldwide major public health concern associated with increased cardiometabolic risk (CMR) in adults. The rapid growth of technology and busier lifestyles cause society to have a longer period of sitting time which causes Hypertension and worsens other CMR. Objective: We aimed to evaluate whether prolonged standing time may decrease CMR among overweight and obese adults.

Methods:

Studies were searched from Pubmed, Cochrane, Science Direct/Clinicalkey up to December 2019. We included studies of any design that evaluate sitting time and standing time to CMR among overweight and obese adults. Effect sizes were expressed as mean difference (MD), 95% Confidence interval (CI), and p-value <0.05.

Results:

Five eligible studies including 220 participants (1 RCT, 2 randomized crossover trial, and 2 observational studies) were included in this study. All studies compared standing versus sitting time. We found statistically significant difference in diastolic blood pressure (mmHg) (MD -2.05, 95% CI -2.60, -1.50, 5 studies, p < 0.00001), total cholesterol (mmol/L) (MD -0.38, 95% CI -0.67, -0.09, 2 studies, p = 0.01), LDL-cholesterol (mmol/L) (MD -0.38, 95% CI -0.65, -0.12, 2 studies, p = 0.005), and fasting glucose (mmol/L) (MD 0.10, 95% CI 0.05, 0.16, 3 studies, p = 0.0003). No statistically significant difference in systolic blood pressure (mmHg) (MD -1.67, 95% CI -3.37, 0.02, 5 studies, p = 0.05), triglycerides, HDL-cholesterol, weight, BMI, and waist circumference.

Conclusion:

Some studies show a statistically significant difference between prolonged standing and sitting time in CMR among overweight and obese adults. Further randomized controlled trials are needed to explore more to this issue.
18. THE ROLE OF EDUCATION AND LIFESTYLE MODIFICATION IN CONTROLLING BLOOD PRESSURE AMONG HYPERTENSIVE PATIENTS IN MOH RIDWAN MEURAKSA ARMY HOSPITAL
Authors: Adiwinata Sheila , Librantoro
Published: May 2021

Background:

Blood pressure control rates in patients treated with pharmacotherapy remain low. Recent guidelines for the management of arterial hypertension suggest that lifestyle changes are useful and effective to reduce blood pressure and global cardiovascular risk.

Objective:

This study was undertaken to give us insight on role of education and lifestyle modification in controlling blood pressure among hypertensive patients.

Method:

50 patients with uncontrolled blood pressure in Moh Ridwan Meuraksa Army Hospital in 2018 are eligible for the study. Data of BMI, smoking status, physical activity, alcohol consumption, diet, and blood pressure were collected. Then patients were educated about definition, risk factors, complications of hypertension, given treatment of hypertension, counselling on lifestyle changes, The DASH diet, and monthly routine check up. After 3 months follow up, post intervention data were collected.

Result:

5 patients were lost to follow up. 5 of 45 uncontrolled hypertensive patients have knowledge of hypertension. After counselling, 7 patients quit smoking, 4 patients quit consuming alcohol, 27 patients routinely implementation of DASH diet and 16 patients routinely physical activity (5 times a week, 30 minutes each). Based on BMI data, 11 obese (24.45%) and 29 overweight patients (64.44%) decrease to 7 obese (2.44%) and 30 overweight patients (66.67%). 3 patients turn to normal BMI. After 3 months follow up, 39 of 45 patients achieved blood pressure target.

Conclusion:

Education and lifestyle modification are effective in increasing awareness of hypertension and achieving blood pressure target. Further study is needed to decrease cardiovascular mortality in hypertension patients
19. FACTORS CONTRIBUTING HYPERTENSION IN YOUNG ADULT PATIENTS IN MOH RIDWAN MEURAKSA ARMY HOSPITAL
Authors: Adiwinata Sheila , Librantoro
Published: May 2021

Background:

Hypertension is a major health problem which contributing for cardiovascular disease and other complications. Nowadays, the incidence of hypertension in young population is increasing. Many factors contribute the occurrence of hypertension in young adults.

Objective:

This study is to determine factors contributing hypertension in young adult patient in Moh Ridwan Meuraksa Army Hospital.

Method:

This study was carried out a cross sectional study that utilized medical record from Moh Ridwan Meuraksa Army Hospital within January to December 2019. Patients aged ≤45 years with Systolic Blood Pressure ≥140 mmHg and Diastolic Blood Pressure ≥90 mmHg were included. Risk factors data such as gender; BMI; smoking status; family history of hypertension; and physical activity statuses were collected. The exclusion criteria were patients with any other cardiac, kidney and vascular disease.

Result:

91 hypertensive young patients were selected during January to December 2019, 51 patients (56.04%) are male and 40 patients (43.96%) are female. 62 patients (68.13%) with grade 1 hypertension, 28 patients (30.77%) with grade 2 hypertension and 1 patient (1.10%) with grade 3 hypertension. Based on BMI, 41 patients (45.06%) are overweight and 26 patients (28.57%) are obese. According risk factors data, absent of physical activity is the highest prevalence (69.23%) then followed by smoking (61.54%) and family history of hypertension (58.24%).

Conclusion:

This study revealed that the highest risk factor that contributing hypertension in young adult patients is absent of physical activity. Further study is needed to prevent cardiovascular mortality in younger population.
20. SERUM GUT-DERIVED METABOLITE TRIMETHYLAMINE N-OXIDE CONCENTRATION IS ASSOCIATED WITH RISK OF PRE-ECLAMPSIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kamarullah William , Angelina Monica , Suratinoyo Adis Tiara
Published: May 2021

Background:

The gut microbial metabolite trimethylamine N-oxide (TMAO) is gradually deemed as a novel risk factor for cardiovascular events. However, there is limited evidence about the role of TMAO in pre-eclampsia.

Objective:

The aim of this systematic review and meta-analysis is to assess the association of TMAO in pre-eclampsia.

Methods:

PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar were systematically searched from inception up to January 2021. The standardized mean difference (SMD) with 95% confidence interval (CI) were estimated and pooled to investigate the effect sizes.

Results:

Three eligible articles that met the study criteria were included in the current meta-analysis. Overall, the higher serum TMAO level was significantly associated with risk for pre-eclampsia (SMD = 0.87, 95% confidence interval [CI] = 0.29–1.46, Z = 2.94, P = 0.003) compared with healthy control. A significant heterogeneity among studies was observed (I
2 = 85%; P-heterogeneity = 0.001). Hence, we conducted subgroup analyses of severity status to investigate the source of heterogeneity. Consistent results were obtained in all examined subgroups as well as in the sensitivity analysis. The risk for severe pre-eclampsia for higher serum TMAO was 1.16 (95% CI = 0.69–1.62, Z = 4.85, P < 0.00001) compared with control group although no significant difference was observed concerning the association between serum TMAO level and mild pre-eclampsia (SMD = 0.44, 95% CI = 0.27–1.15, Z = 1.21, P = 0.22).

Conclusion:

The current meta-analysis shows that higher serum TMAO amount was associated with increased risk of pre-eclampsia.
22. ASSOCIATION BETWEEN SYSTOLIC BLOOD PRESSURE, DIASTOLIC BLOOD PRESSURE, AND MEAN ARTERIAL PRESSURE ON ADMISSION WITH THE INTENSIVE CARE UNIT LENGTH OF STAY, TOTAL LENGTH OF STAY, AND IN-HOSPITAL MORTALITY AMONG ALL-CAUSE ACUTE HEART FAILURE PATIENTS
Authors: Haloho SRNA , Fahmi Z , Rahman FA , Delfian T
Published: May 2021

Background:

Acute heart failure (AHF) is a life-threatening condition that increase the intensive care unit and total length of stay and also the risk of in-hospital mortality. It has been widely known that blood pressure components are some of the prognostic factors of heart failure.

Objective:

To determine association between two main blood pressure components, systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as mean arterial pressure (MAP) in the clinical settings.

Methods:

We reviewed the medical records of 50 patients admitted to intensive care unit (ICU) for all-cause acute heart failure within a year. We use three days for ICU and four days for total length of stay (LOS) as the reference categories.

Results:

Median age, SBP, DBP, and MAP were 63.5 years, 140 mmHg, 80 mmHg, and 103 mmHg, respectively. A statistically significant association was present between SBP (p < 0.018), DBP (p < 0.006), and MAP (p < 0.007) on admission with in-hospital mortality. There was no association found between SBP, DBP, and MAP with the shorter and longer ICU and total length of stay.

Conclusion:

Among all-cause AHF patients admitted to the ICU, the SBP, DBP, and MAP on admission was associated with in-hospital mortality, respectively.
23. DESCRIPTION OF THE CHARACTERISTICS OF PATIENTS WITH HYPERTENSION AT THE AL-IHSAN HOSPITAL ELDERLY POLYCLINIC WEST JAVA PROVINCE IN 2020
Authors: Andanita Adisya , Sutadipura Nugraha , Nurmeliani Ratna
Published: May 2021

The elderly population is predicted to continue to increase every year. Hypertension is the second highest health problem in the elderly which is characterized by an increase in systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg. Based on the causes, hypertension is divided into two, namely primary hypertension, sedentary lifestyle (inactivity), diet, gender, genetic factors and secondary hypertension caused by certain medical conditions or drugs. Diabetes mellitus (DM), hypercholesterolemia, and hyperuricemia are diseases that trigger hypertension. The purpose of this study was to describe the characteristics of hypertensive patients in the Elderly Polyclinic of Al-Ihsan Hospital, West Java Province in 2020. This study used a descriptive method with a cross-sectional study design. The data obtained came from medical records at the Al-Ihsan Regional Hospital, West Java Province with patients diagnosed with hypertension in the January-November 2020 period. The results showed that most of the elderly patients who had hypertension were women as many as 54 people (52.4%), DM 39 people (37.9%), hypercholesterolemia in 31 people (30.1%), and hyperuricemia 23 people (22.3%). In conclusion, hypertensive patients in elderly polyclinics were mostly women, fewer had DM, hypercholesterolemia, and hyperuricemia.
31. HYPERTENSION AND RISK OF MORTALITY IN STROKE JAVANESE PATIENTS IN NEURO HCU DR. MOEWARDI HOSPITAL SURAKARTA
Authors: Hamidi Baarid Luqman , Kirana Dewi Hayu , Mirawati Diah Kurnia , Danuaji Rivan , Subandi  , Budianto Pepi , Hambarsari Yetty , Prabaningtyas Hanindya
Published: May 2021

Background:

Worldwide, stroke is the second leading cause of death and the third leading cause of disability. According to WHO in 2016, 70% of stroke cases were found in low and middle income countries, 87% of deaths from stroke were also found in these countries.

Objective:

This study aims to determine the factors that influence the mortality of stroke patients.

Method:

This study was conducted on all stroke patients in the Neuro HCU Dr. Moewardi Hospital in the period January to June 2020. The independent variables were assessed for their effect on patient mortality using a quantitative observational analytic approach with logistic regression analysis.

Results:

There were 124 patients in this study. From eleven variables, only hypertension and stroke type passed the verification test. Further tests were carried out and it was found that patients with hypertension and subarachnoid hemorrhage (SAH) had the highest probability of mortality (0.888).

Conclusion:

The probability of mortality for hypertension and SAH in this study is in accordance with previous studies that hypertension increases the risk of mortality in stroke patients and SAH patients have high mortality and morbidity rates. Therefore, optimizing the management of blood pressure and SAH is needed to reduce the mortality of stroke patients.
37. CORRELATION BETWEEN BMI AND BSA WITH CARDIAC REHABILITATION PARAMETERS IN CAD PATIENTS WITH AND WITHOUT HYPERTENSION WHO UNDERWENT PCI
Authors: Rantung NOH , Sarayar AM , Setiawan S , Loway CA , Budiono AB , Soemara G , Joseph VFF , Lampus NS , Pangemanan JA , Panda AL
Published: May 2021

Background:

Cardiovascular diseases (CVDs) are the number 1 cause of death globally, taking an estimated 17.9 million lives annually. Hypertension is an independent risk factor for CVDs, including coronary artery disease (CAD). Obesity is a growing problem, and studies have reported a protective effect from obesity compared with normal BMI for adverse outcomes after PCI. Several studies have shown a paradox regarding the independent association between elevated BMI with reduced mortality after PCI, whether in stable and more acute clinical settings. Better cardiac rehabilitation parameter in CAD patients has also been shown to be associated with better physical health, quality of life, regardless of other risk factors.

Purpose:

This study aims to find the correlation between BMI and BSA with cardiac rehabilitation parameters in CAD patients who underwent PCI.

Methods:

77 CAD patients were included in the study. Statistical analysis using Pearson's Correlation was done using SPSS to find a correlation between BSA and BMI with exercise capacity using metabolic equivalents (METs) and a six-minute walk test (6MWT) before hospital discharge.

Results:

We found significant correlation between METs (p = 0.01, r = 0.302) and 6MWT (p = 0.025, r = 0.264) with BSA, but not with BMI. The correlation remains significant in the hypertensive group only.

Conclusions:

There is a statistically significant correlation between cardiac rehabilitation parameters with BSA in CAD patients who underwent PCI.
44. RELATIONSHIP BETWEEN HYPERTENSION AND HYPONATREMIA IN CORONAVIRUS DISEASE PATIENTS: A CROSS-SECTIONAL STUDY
Authors: Wulandari Ayu Pramitha , Nugroho Dhani Tri Wahyu
Published: May 2021

Background

: Hypertension has been presumed to be associated with the severity of coronavirus disease (COVID-19) related to angiotensin-converting enzyme 2 (ACE2). Besides, hyponatremia is the most common electrolyte disorder in COVID-19 patients and has been reported to be associated with increased mortality.

Objective:

This study aimed to evaluate the association between hypertension and hyponatremia in COVID-19 patients who were admitted to Wahidin Sudirohusodo General Hospital Mojokerto.

Method:

In this study, we cross-sectionally investigated COVID-19 patients who were admitted to Wahidin Sudirohusodo General Hospital Mojokerto between December 2020 and January 2021. According to medical records, we evaluated COVID-19 patients who have hypertension as comorbidities and hyponatremia from laboratory results.

Result:

There were 98 COVID-19 patients consisted of 50 men and 48 women included in this study. The mean number of patients’ age was 55.6 ± 12.4 years. The prevalence of hypertension among patients was 55.1%. The mean number of sodium level was 131.50 ± 11.29 mmol/L. There was a strong correlation between blood pressure and sodium balance disorders (p < 0.002). Hypertension was associated with a nearly 5.5-fold increased risk of hyponatremia in COVID-19 patients (OR 5.06; 95% CI: 1.66–15.4; p < 0.05).

Conclusion:

Hypertension comorbidity was associated with a higher risk of hyponatremia in COVID-19 patients.
49. THE ASSOCIATION BETWEEN ADMISSION BLOOD PRESSURE AND OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Ardining Hiradipta , Amshar Mohamed , Ulfiarakhma Dela , Napu Ramang , Karimullah Muchammad Dzikrul Haq , Widyantoro Bambang
Published: May 2021

Background:

In patients with acute coronary syndrome (ACS), the role of admission blood pressure (BP) on outcomes remains inconclusive.

Objective:

This study aimed to investigate the association between admission BP and various outcomes in patients hospitalized for ACS.

Method:

In this cross-sectional study, 279 patients who admitted with ACS to Kediri District Hospital and Bogor General Hospital between January and June 2020 were included. Data were analyzed using SPSS software v25.

Result:

There was association between hypertension status on admission and diagnosis; there were more hypertensive patients with non-ST segment elevation (NSTE) ACS compared to ST segment elevation (STE) ACS diagnosis (p = 0.002); and significant difference on admission systolic BP between STE-ACS and NSTE-ACS patients (p < 0.00001). Patients who died during hospitalization had significantly lower admission systolic BP compared to survived patients (p = 0.001). Patients with reduced ejection fraction (EF) on follow-up echocardiography had significantly lower admission systolic BP compared to patients with normal EF (p = 0.014). Patients with diastolic dysfunction on follow-up echocardiography had significantly higher admission systolic BP compared to patients without diastolic dysfunction (p = 0.009). No significant difference on length of stay between hypertensive and non-hypertensive patients (p = 0.416).

Conclusion:

Lower admission systolic BP was associated with increased in-hospital mortality and reduced EF, while higher systolic BP was associated with diastolic dysfunction.
57. VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH MAJOR ADVERSE CARDIAC EVENTS (MACE) IN CARDIOLOGY CLINIC DR. M. DJAMIL HOSPITAL PADANG
Authors: Metasari Sisca , Fernando Harben , Ferdian Vicky , Yanni Mefri , Syafri Masrul , Syukri Muhammad
Published: May 2021

Background:

Elevated blood pressure variability has been associated with a major risk factor for cardiovascular events and mortality. Long-term BPV has also been described, including seasonal BP variation changes between clinic visits over months or years (visit-to-visit BPV).

Objective:

This study aims to investigate the association of visit-to-visit variability of systolic blood pressure with major adverse cardiac events.

Methods:

This was a retrospective study based on medical records in Dr. M. Djamil Hospital, Padang. Hypertensive patients (N = 187) without a history of major adverse cardiac events before were follow-up duration from June-December 2019. Visit-to-visit variability was measured by standard deviation and correlation of the two variable using the ANOVA test (p-value <0.05)

Results:

Female was the dominant characteristic observed in our study (n = 53.5%), followed by elderly (n = 87.7%), smoker (n = 39.6%), ACEI/ARB therapy (n = 34.8%) and pre-hypertension condition (n = 59.9%). The mean age of the study population was 59.13. The mean systolic blood pressure variability at the first visit was 132.9 dan no statistically significant difference afterward. The visit-to-visit variability of systolic blood pressure was significantly associated with the occurrence of major adverse cardiac events (rehospitalization due to MI, heart failure, arrhythmia, and death) p-value = 0.001 (p < 0.05).

Conclusion:

Female gender, elderly, pre-hypertension condition, smoker, and ACE/ARB therapy were the dominant patterns in our study. Increased visit-to-visit variability blood pressure was significantly associated with increasing the occurrence of major adverse cardiac events among hypertensive patients in clinical treatment
60. LEFT VENTRICULAR GEOMETRY AND CLINICAL OUTCOMES IN HYPERTENSIVE PATIENTS WITH NORMAL EJECTION FRACTION
Authors: Maulana Giovanno Rachmanda , Widyastuti Wenny , Azzuhdi Muhammad Zakiy , Yanni Mefri
Published: May 2021

Background:

In hypertensive populations, left ventricular (LV) geometry, which is characterized by different types of hypertrophy, predicts cardiovascular outcome.

Objective:

To evaluate the prevalence and clinical outcomes of various LV geometric patterns in hypertensive patients admitted with normal EF (>55%) who were referred for echocardiography examination.

Methods:

We obtained relevant clinical and echocardiographic data from our clinical echocardiographic database of 176 hypertensive patients admitted with various cause during 2018 - 2019 who met the inclusion criteria and absence condition of valvular heart disease. Clinical outcome obtained from medical record and direct contact to the patients. Subjects were arbitrarily categorized according to the LV geometric pattern into LV concentric remodelling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH), and normal groups. Statistical analysis was performed using SPSS 26.

Results:

LV concentric hypertrophy was the most common abnormal LV geometric pattern observed in our study (n = 103), followed by concentric remodelling (n = 53). Diastolic dysfunction was more frequent found in CH group compared to CR and EH group, and no statistically significant relationship was found (p value = 0.247). Diabetes mellitus was statistically significant in all four groups (p < 0.001). The most frequent medication being prescribed was Ca channel blocker. There was no statistically significant relationship between the four groups and the incidence of rehospitalization (p = 0.573). However, the CH group accounted for the highest rehospitalization rates among the four groups (n = 13). The most frequent cause of rehospitalization in this study was non-cardiac causes (n = 14), while the most common cardiac cause for rehospitalization was acute coronary syndrome (n = 10).

Conclusion:

Diabetes mellitus was statistically significant in all four groups. But, there was no statistically significant relationship between the four groups and the incidence of rehospitalization.
66. ASSOCIATION HYPERTENSION AND RISK FACTORS OF COGNITIVE IMPAIRMENT IN THE ELDERLY WITHOUT DIABETES: ATMA JAYA ACTIVE AGING RESEARCH STUDY
Authors: Turana Yuda , Suryakusuma Linda , Barus Jimmy F , Andre  , Suswanti Ika , Handajani Yvonne S
Published: May 2021

Introduction:

Cognitive impairment is often associated with aging and a history of cardiovascular disease. This study aims to determine the relationship between hypertension and other risk factors for cognitive disorders in the elderly without diabetes.

Methods:

This study uses secondary data in Atma Jaya Cognitive and Aging studies, 2013–2017 on 711 elderly. Subjects with fasting blood sugar ≥126 mg/dl (n = 94) and incomplete data (n = 127) were excluded in this study. Subjects that can be analyzed are as many as 490 elderly.

The variables studied were demographic characteristics, lipid profile, hypertension status, smoking and depression. Subjects are categorized as experiencing cognitive impairment if they have an MMSE score <24. The bivariate statistical test was performed using the chi-square analysis and the mean Whitney test, while the multivariate analysis used multiple logistic regression.

Result:

Most of the subjects were female (68%), with a mean age of 66.8 ± 7.8 years, and having education <9 years (62.7%), and as many as 204 (41.5%) subjects experienced cognitive impairment. The bivariate analysis results showed that female gender, low education, and hypertension were independently associated with poorer cognitive function (p < 0.05). Multivariate analysis showed that education <9 years was found to be the dominant factor in cognitive impairment (p-value <0.05; OR = 10.855), after being controlled by gender and hypertension variables.

Conclusion:

Female gender, low education and hypertension are associated with impaired cognitive function. Low education was found to be the dominant factor in cognitive impairment in non-diabetic elderly.
68. ASSOCIATION OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKER DRUGS AND OUTCOMES IN COVID-19 PATIENTS WITH HYPERTENSION
Authors: Yanni Mefri
Published: May 2021

Background:

The role of renin-angiotensin-aldosterone system (RAAS) blockers during the coronavirus disease 2019 (COVID-19) pandemic is a matter of controversies. Studies based on in-hospital exposure have suggested a beneficial effect of these drugs, unlike those based on chronic exposure.

Objective:

To analyse RAAS blocker prescription before and during hospital stay and clinical outcomes in patients with COVID-19. The primary outcome was in-hospital mortality within 30 days of admission. The secondary outcome was a severe disease defined as the need for high flow nasal cannula (HFNC), ICU admission, or death, within 30 days of admission.

Methods:

A retrospective cohort study was conducted in 112 hypertensive patients hospitalized for COVID-19 during March until December 2020. The association between exposure and outcomes within hospitalization was analysed using logistic regression analysis.

Results:

Of 112 patients, mean age was 56.33 ± 12.9 years, 61 (54.5%) were male, with mean Systolic BP was 147 ± 25.4 and mean Diastolic BP was 86.6 ± 14.2 mmHg in all groups. There were 86 (76.7%) patients had prior use of RAAS blocker at admission. Baseline characteristics showed significant difference on peripheral SpO2 saturation at admission between prior use and without prior use of RAAS blockers groups, 96.8 ± 3.5% vs 94 ± 9.13%, p = 0.046, and use of Ca channel blocker drugs 65 (75.6%) vs 14 (53.8%), p = 0.03, respectively. Overall mortality was 22 (19.6%) in both groups. Among patients with prior exposure to RAAS blockers, 20.9% died within 30 days of admission versus 15.4% in patients without prior exposure to RAAS blockers [OR 1.28 (95% CI, 0.39–4.23), p = 0.67] and 25.6% patients suffered severe disease vs 26.9% in patients without prior exposure to RAAS blockers [OR 0.12 (95% CI, 0.01–0.74), p = 0.02].

Conclusions:

Mortality was found higher in patients with prior exposure to RAAS blockers than in patients without prior exposure to RAAS blockers. There was no significant association between RAAS drugs exposure and mortality in COVID-19 patients, but patients with no prior RAAS blockers prescription tend to suffer severe disease (need for ICU admission, use of HFNC) than other group.
70. ASSOCIATION BETWEEN HYPERTENSION AND IN-HOSPITAL MORTALITY IN COVID-19 PATIENTS
Authors: Allo Iswandy Janetputra Turu’ , Tiksnadi Badai Bhatara , Prakoso Pranata Priyo , Najiyah Hana Hadianty , Rahmawati Mira , Hasmirani Mira , Wibowo Robin Hendra , Utomo Priyanto , Yudisman Ade
Published: May 2021

Background:

Indonesia reported ≥1 million cases of Coronavirus Disease (COVID-19) with remarkable number of deaths. Notably, hypertension's status as predictor for poorer outcome remains debatable.

Objective:

We aim to investigate the association between in-hospital mortality and hypertension in COVID-19 patients.

Methods:

A retrospective study using adult (≥18 years old), confirmed COVID-19 patients’ medical record at Cibabat General Hospital, Cimahi, West Java, Indonesia between September to December 2020 was conducted. Patient's gender, age, hospital-stay length, comorbidities (type 2 diabetes mellitus, coronary artery diseases, arrythmia, kidney diseases, respiratory diseases, and stroke), and outcomes were collected. Hypertension was defined as hypertension history before the infection. Chi-square and logistic regression analysis were conducted to understand the association between hypertension and mortality.

Results:

A total of 205 patients were included, 117 (57.1%) were males, of whom 40 (19.5%) died and 165 (80.5%) were discharged. The mean value of the patients’ age was 53.7 ± 13.8 years old, and the median hospitalization-day was 11 (range: 1–45) days. Hypertension was the most common comorbidity (n = 72; 35.1% patients); 13 (18.1%) were dead and 59 (81.9%) survived. A chi-square test showed no statistically significant difference between mortality and hypertension, X
2 (1, N = 205) = 0.15, p = 0.70; OR: 0.87, 95% confidence interval (CI) 0.42–1.80. Logistic regression analysis reveals that patient's age is the only statistically significant factor for death in this study (p < 0.05; OR: 1.05, 95% CI 1.02–1.08).

Conclusion:

Hypertension is not associated with mortality in COVID-19 patients. Further investigations including larger sample size and more possible variables are warranted to understand this relationship further.
73. OMECAMTIV MECARBIL, A NOVEL THERAPEUTIC AGENT FOR HEART FAILURE WITH REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW
Authors: Trifitriana Monica , Mulawarman Rido , Felani Muhammad Rizky , Tondas Alexander Edo
Published: May 2021

Background:

At least half of the millions of heart failure patients have heart failure with reduced ejection fraction (HFrEF). There have been many drugs used to treat heart failure, but these drugs don’t directly work on the target pathogenesis of HFrEF. Improving systolic function will prevent neurohormonal activation and ventricular remodeling, which clinically will provide better results from hospitalization and causes of death. Omecamtive mecarbil (OM) is a novel selective cardiac myosin activator, it will improve cardiac function in patients with HFrEF.

Objective:

We aim to assess the latest evidence on the outcome of OM in heart failure patients.

Method:

We performed a comprehensive search on topics that assesses OM outcomes in heart failure patients from inception up until January 2021.

Results:

There were 17.712 HFrEF patients from six studies. Three studies showed the decrease of heart rate, two studies prove that OM increase the stroke volume and systolic ejection time, while each of one study showed increase of left ventricular ejection fraction and decrease left ventricular end systolic volume, left ventricular end diastolic volume, left ventricular fraction shortening, left ventricular end systolic dimension and left ventricular end diastolic dimension from the baseline. The route via intravena maximum tolerated by dose 0,5 mg/kg per h, while via orally start with dose 25 mg twice daily. No significant side effects were found. One randomized controlled trial study also showed a lower risk of a composite heart failure events and cardiovascular death than those who received placebo.

Conclusion:

Omecamtiv mecarbil improved cardiac function in heart failure and could be the first in class of a new therapeutic agent. Further controlled studies are warranted for definite conclusion.
Acupuncture treatment for nausea and vomiting after chemotherapy
Authors: Hou Xian-Bing , Chen Dan-Dan , Cheng Tong-Fei , Wang Dan , Dai Xiao-Jun , Wang Yao , Cui Bi-Xian , Wang Yuan-Yuan , Xu Hui , Chen Hong-Zhou
Published: May 2021

Background:

Chemotherapy-induced nausea and vomiting (CINV) are 1 of the main obstacles to continuous treatment. External treatment of Chinese medicine has been widely used in the treatment of CINV, especially acupuncture therapy, but studies about overall safety and effectiveness of acupuncture treatment have not been scientifically and methodically evaluated in recent years. Evaluating the overall safety and effectiveness of acupuncture treatment in patients with CINV is the purpose of this review.

Methods and analysis:

Relevant randomized controlled trials are being searched in the following electronic databases: PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure, Chinese Scientifific Journal Database, Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database. We will also attempt to obtain the unpublished academic data by contacting the colleague, professor, or Institute of Traditional Chinese Medicine. The RCTs of the acupoint therapies for CINV patients will be searched in the databases from inception to December 2020. The primary outcomes are defined as severity, duration and frequency of nausea or vomiting, or both. The secondary outcomes are defined as any adverse events and quality of life. Performing the meta-analysis by using RevMan version 5 software. Mean difference or standardized mean difference will express the continuous variables, while relative risk (RR) will express the categorical variables.

Results:

The results of this review will provide a high-quality synthesis to evaluate the effectiveness and safety of acupuncture treatment for CINV.

Conclusion:

This review will provide evidence to estimate whether acupuncture treatment is effective interventions for CINV.

Dissemination:

This systematic review will provide evidence for the effectiveness of acupuncture treatment in the intervention of CINV. The purpose is to provide new ideas and methods for the treatment of CINV. The results of this systematic review will be disseminated through various forms of presentation and publication of data in journals or electronic databases.

PROSPERO registration number:

CRD42021225872
Celiac plexus neurolysis for abdominal cancers: going beyond pancreatic cancer pain
Authors: Ambai Vats T. , Singh Vinita , Boorman David W. , Neufeld Nathan J.
Published: May 2021

Introduction:

Celiac plexus neurolysis (CPN) has been verified for mitigating pancreatic cancer pain. However, information regarding CPN's use beyond this remains limited.

Objectives:

Identify which cancers benefit from CPN, which symptoms improve, and when symptoms improve.

Methods:

Retrospective analysis was conducted on 173 patients who received CPN for pain caused by various malignancies. Mean symptom changes on the MD Anderson Symptom Inventory (MDASI) from baseline to 2 weeks, 1 month, and 2 months after CPN were analyzed overall and then by cancer type: pancreatic (all stages and stages III–IV), hepatobiliary, and nonpancreatic, nonhepatobiliary gastrointestinal (NPNH-gastrointestinal).

Results:

Eighty-two pancreatic, 43 NPNH-gastrointestinal, 14 hepatobiliary, and 34 patients with other cancers met inclusion criteria. Statistically significant changes included decrease in the pain score at 1 month by 1.01 points for all cancers, 1.65 points for all pancreatic cancers, and 1.88 points for late-stage pancreatic cancers. At 2 months, pain decreased by 1.50 points for all cancers, 1.68 points for all pancreatic cancers, 2.37 points for late-stage pancreatic cancers, and 1.50 points in NPNH-gastrointestinal cancers. At 2 months, quality of life improved by 1.07 points for all cancers and 1.53 points for all pancreatic cancers. Sleep improved at 2 months for all cancers by 0.73 points and 1.60 points in late-stage pancreatic cancers. At 2 months, pancreatic cancer patients improved in general activity by 0.93 points, walking by 1.00 points, and working by 1.12 points.

Conclusion:

Celiac plexus neurolysis can decrease cancer symptom burden beyond pain including quality of life and sleep for pancreatic and nonpancreatic cancers, as well as general activity for pancreatic cancers.
Dual-Energy Computed Tomography for the Diagnosis of Mediastinal Lymph Node Metastasis in Lung Cancer Patients: A Preliminary Study
Authors: Hu Xiaoli , Gu Qianbiao , Zhang Kun , Deng Dong , Li Lei , Li Ping , Shen Hongrong
Published: May 2021

Objective

This study explored the feasibility of dual-energy computed tomography (DECT) for the diagnosis of mediastinal lymph node (LN) metastasis in patients with lung cancer.

Methods

Forty-two consecutive patients with lung cancer, who underwent DECT, were included in this retrospective study. The attenuation value (Hounsfield unit) in virtual monochromatic images and the iodine concentration in the iodine map were measured at mediastinal LNs. The slope of the spectral attenuation curve (K) and normalized iodine concentration (in thoracic aorta) were calculated. The measurement results were statistically compared using 2 independent samples t test. Receiver operating characteristic curve analysis, net reclassification improvement, and integrated discrimination improvement were used to evaluate the diagnostic performance of DECT for mediastinal LN metastasis.

Results

A total of 74 mediastinal LNs were obtained, including 33 metastatic LNs and 41 nonmetastatic LNs. The attenuation value at the lower energy levels of virtual monochromatic images (40–90 keV), K, and normalized iodine concentration demonstrated a significant difference between metastatic LNs and nonmetastatic LNs. The attenuation value at 40 keV was the most favorable biomarker for the diagnosis of mediastinal LN metastasis (area under curve, 0.91; sensitivity, 0.94; specificity, 0.81), which showed a much better performance than the LN diameter-based evaluation method (area under curve, 0.72; sensitivity, 0.66; specificity, 0.82; net reclassification improvement, 0.359; integrated discrimination improvement, 0.330).

Conclusions

Dual-energy computed tomography is a promising diagnostic approach for the diagnosis of mediastinal LN metastasis in patients with lung cancer, which may help clinicians implement personalized treatment strategies.
Examining the Effects of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Autologous Breast Reconstruction
Authors: Patel Ashraf A. , Arquette Connor P. , Yesantharao Pooja S. , Borrelli Mimi R. , Broderick Kristen P. , Cheesborough Jennifer E. , Lee Gordon K. , Nazerali Rahim S.
Published: May 2021

Background

Postmastectomy radiation therapy (PMRT) is known to increase the risk of multiple adverse outcomes after breast reconstruction. In the context of delayed-immediate autologous breast reconstruction, PMRT is typically conducted after placement of subpectoral (SP) tissue expanders. With the re-emergence of prepectoral (PP) reconstruction, there are little data assessing the outcomes of PP reconstruction in breasts receiving PMRT. We compared postoperative outcomes of PMRT patients undergoing delayed-immediate, autologous breast reconstruction with placement of tissue expanders in either the PP or SP plane.

Methods

A retrospective chart review was conducted on all consecutive patients who underwent delayed-immediate autologous breast reconstruction and received PMRT at either the Stanford University or the Johns Hopkins University Hospitals between January 2009 and December 2018. Demographics, comorbidities, perioperative information, and oncologic data were collected for all patients. Complications were collected and analyzed after stage 1 surgery, between 30 days of stage 1 and up to stage 2 surgery, and after stage 2 surgery. Multivariable regressions were used to determine predictors of 1 or more complications.

Results

A total of 71 patients (73 breasts) were included. Prepectoral reconstruction comprised of 52.2% of the cohort, and the remaining 47.8% were SP reconstructions. Demographics and comorbidities were similar between groups, except for premastectomy radiation, which was more prevalent in the PP cohort (P = 0.010). Complications were similar between cohorts after stage 1 surgery (P = 0.420), between stages 1 and 2 (P = 0.100), and after stage 2 (P = 0.570). There were higher rates of skin necrosis in the SP cohort between stages 1 and 2 (PP: 2.6%, SP: 20%, P = 0.004). Multivariable analysis revealed body mass index to be the only predictor of complication (P = 0.041). The mean number of revisionary surgeries was higher in the SP cohort (PP: 0.8 vs SP: 1.9, P = 0.002). The mean follow-up was 385.5 days and similar between groups (P = 0.870).

Conclusions

Rates of overall complication were similar between PP and SP expander placement. However, in SP reconstructions, skin necrosis was significantly higher between stages 1 and 2. The patients in the SP cohort also underwent a greater number of revisionary surgeries, although overall rates of pursuing any revisionary surgery were similar between groups.
Incidence and Impact of Dysglycemia in Patients with Sepsis Under Moderate Glycemic Control
Authors: Fujishima Seitaro , Gando Satoshi , Saitoh Daizoh , Kushimoto Shigeki , Ogura Hiroshi , Abe Toshikazu , Shiraishi Atsushi , Mayumi Toshihiko , Sasaki Junichi , Kotani Joji , Takeyama Naoshi , Tsuruta Ryosuke , Takuma Kiyotsugu , Yamashita Norio , Shiraishi Shin-ichiro , Ikeda Hiroto , Shiino Yasukazu , Tarui Takehiko , Nakada Taka-aki , Hifumi Toru , Otomo Yasuhiro , Okamoto Kohji , Sakamoto Yuichiro , Hagiwara Akiyoshi , Masuno Tomohiko , Ueyama Masashi , Fujimi Satoshi , Yamakawa Kazuma , Umemura Yutaka
Published: May 2021

Glycemic control strategies for sepsis have changed significantly over the last decade, but their impact on dysglycemia and its associated outcomes has been poorly understood. In addition, there is controversy regarding the detrimental effects of hyperglycemia in sepsis. To evaluate the incidence and risks of dysglycemia under current strategy, we conducted a preplanned subanalysis of the sepsis cohort in a prospective, multicenter FORECAST study. A total of 1,140 patients with severe sepsis, including 259 patients with pre-existing diabetes, were included. Median blood glucose levels were approximately 140 mg/dL at 0 and 72 h indicating that blood glucose was moderately controlled. The rate of initial and late hyperglycemia was 27.3% and 21.7%, respectively. The rate of early hypoglycemic episodes during the initial 24 h was 13.2%. Glycemic control was accompanied by a higher percentage of initial and late hyperglycemia but not with early hypoglycemic episodes, suggesting that glycemic control was targeted at excess hyperglycemia. In nondiabetic patients, late hyperglycemia (hazard ratio, 95% confidence interval; P value: 1.816, 1.116–2.955, 0.016) and early hypoglycemic episodes (1.936, 1.180–3.175, 0.009) were positively associated with in-hospital mortality. Further subgroup analysis suggested that late hyperglycemia and early hypoglycemic episodes independently, and probably synergistically, affect the outcomes. In diabetic patients, however, these correlations were not observed. In conclusion, a significantly high incidence of dysglycemia was observed in our sepsis cohort under moderate glycemic control. Late hyperglycemia in addition to early hypoglycemia was associated with poor outcomes at least in nondiabetic patients. More sophisticated approaches are necessary to reduce the incidence of these serious complications.
The Use of Ancillary Services Under a Bundled Care Versus a Fee-For-Service Payment Model
Authors: Caldwell Lauren , Halder Gabriela E. , Nutt Stephanie , Rogers Rebecca G. , Wright Michelle L. , Baum Audrey , White Amanda B.
Published: May 2021

Objectives

Colocated services in a team-based integrated practice unit (IPU) optimize care of pelvic floor disorders. Our goal was to compare ancillary service utilization in a multidisciplinary IPU between patients covered by a bundled payment model (BPM) versus a traditional fee-for-service model (FFSM).

Methods

Medical records of women attending an IPU for pelvic floor disorders with colocated services, including nutrition, social work, psychiatry, physical therapy, and subspecialty care between October 2017 and December 2018, were included in this retrospective chart review. All patients were offered treatment with ancillary services according to standardized care pathways. Data extracted included patient demographics, pelvic floor disorder diagnoses, baseline severity measures, payment model, and ancillary services used. Univariate and multivariate logistic regression identified variables predicting higher uptake of ancillary services.

Results

A total of 575 women with pelvic floor disorders presented for care during the study period, of which 35.14% attended at least 1 appointment with any ancillary services provider. Ancillary service utilization did not differ between patients in the BPM group and those in the FFSM group (36.22 vs 33.47%; P = 0.489). Social work services were more likely to be used by the BPM compared with the FFSM group (15.95 vs 6.28%; P < 0.001). The diagnosis of fecal incontinence was associated with a higher chance of using any ancillary service (odds ratio, 4.91; 95% confidence interval, 1.81–13.33; P = 0.002).

Conclusions

One third of patients with pelvic floor disorders receiving care in an IPU used colocated ancillary services. Utilization does not differ between payment models.
Regularization by denoising sub-sampled Newton method for spectral CT multi-material decomposition
Authors: Perelli Alessandro , Andersen Martin S.
Published: May 2021

Spectral Computed Tomography (CT) is an emerging technology that enables us to estimate the concentration of basis materials within a scanned object by exploiting different photon energy spectra. In this work, we aim at efficiently solving a model-based maximum-a-posterior problem to reconstruct multi-materials images with application to spectral CT. In particular, we propose to solve a regularized optimization problem based on a plug-in image-denoising function using a randomized second order method. By approximating the Newton step using a sketching of the Hessian of the likelihood function, it is possible to reduce the complexity while retaining the complex prior structure given by the data-driven regularizer. We exploit a non-uniform block sub-sampling of the Hessian with inexact but efficient conjugate gradient updates that require only Jacobian-vector products for denoising term. Finally, we show numerical and experimental results for spectral CT materials decomposition.

This article is part of the theme issue ‘Synergistic tomographic image reconstruction: part 1’.
Synergistic multi-contrast cardiac magnetic resonance image reconstruction
Authors: Qi Haikun , Cruz Gastao , Botnar René , Prieto Claudia
Published: May 2021

Cardiac magnetic resonance imaging (CMR) is an important tool for the non-invasive diagnosis of a variety of cardiovascular diseases. Parametric mapping with multi-contrast CMR is able to quantify tissue alterations in myocardial disease and promises to improve patient care. However, magnetic resonance imaging is an inherently slow imaging modality, resulting in long acquisition times for parametric mapping which acquires a series of cardiac images with different contrasts for signal fitting or dictionary matching. Furthermore, extra efforts to deal with respiratory and cardiac motion by triggering and gating further increase the scan time. Several techniques have been developed to speed up CMR acquisitions, which usually acquire less data than that required by the Nyquist–Shannon sampling theorem, followed by regularized reconstruction to mitigate undersampling artefacts. Recent advances in CMR parametric mapping speed up CMR by synergistically exploiting spatial–temporal and contrast redundancies. In this article, we will review the recent developments in multi-contrast CMR image reconstruction for parametric mapping with special focus on low-rank and model-based reconstructions. Deep learning-based multi-contrast reconstruction has recently been proposed in other magnetic resonance applications. These developments will be covered to introduce the general methodology. Current technical limitations and potential future directions are discussed.

This article is part of the theme issue ‘Synergistic tomographic image reconstruction: part 1’.