bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blunted heart rate reserve during dobutamine stress echocardiography is a predictor of outcome in diabetes and/or chronic kidney disease
Authors: Bellagamba C C A , Torres M A R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A blunted heart rate reserve (HRR) during dobutamine stress echo (DSE) is an index of altered cardiac sympathetic reserve, which is frequently present in diabetes mellitus (DM) or chronic kidney disease (CKD).
Aim
To assess the prognostic value of HRR during DSE.

Methods
We recruited 280 patients (pts) (mean age 62.9 ± 13.1 years); 128 (45.7%) male; 28.2% on beta-blockers at the time of testing) who underwent DSE for known or suspected coronary artery disease and/or heart failure and were followed-up. Four subsets were identified: Group 1 (111 pts without DM or CKD); group 2 (37 with DM without CKD); group 3 (90 with CKD with or without DM); and group 4 (42 with CKD on dialysis). HRR was calculated by EKG as the peak/rest HR ratio.

Results
Ischemia was identified in 34/280 (12.1%) pts. During a median follow-up time of 40.3 ± 30.5 months, 120 events occurred: 46 deaths, 15 non-fatal myocardial infarctions, 23 hospital admissions for acute decompensated heart failure, and 36 myocardial revascularizations. Multivariable comparison of HRR among the 4 groups using post hoc test showed a blunted HRR in group 3 (1.66 ± 0.32) and 4 (1.65 ± 0.27) when compared with group 1 (HRR 1.85 ± 0.35), p &lt; 0.01. Group 2 (1.73 ± 0.28) was not different from any group (p = ns). Groups 3 and 4 were not different between them (p = ns). A post hoc Tukey test for HRR separated in tercils, 1st: HRR &lt; 1.59, 2nd: 1.59 &lt; HRR &lt; 1.86 and 3rd: HRR &gt; 1.86 (p &lt; 0.000). Kaplan-Meier curves showed blunted HRR as an independent predictor of event-free survival in the overall group - 1st: 66.08 ± 5.9 months, 95% CI 54.3-77.7; 2nd: 69.52 ± 6.5, 95% CI 56.6-82.3; 3rd: 90.05 ± 5.3, 95% CI 79.5-100.5. See Figure. HRR was comparable in patients with and without inducible ischemia and off or on beta-blockers.

Conclusion
A blunted HRR during DSE is frequent in patients with DM and CKD, independent of inducible ischemia and use of beta-blockers, and is a useful non-imaging predictor of adverse events.
Abstract Figure. HR ratio and event-free survival curves
Carotid stiffness parameters are earlier markers of subclinical atherosclerosis than central aortic systolic pressure in patients with type 2 diabetes mellitus
Authors: Dimova-Mileva M , Marinova EM 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Elevated central aortic systolic pressure (CASP) is a stronger predictor of atherosclerosis than peripherial blood pressure measurement. One-point echo-tracking is a novel noninvasive method for measurement of the local arterial stiffness (AS) of carotid artery (CA). As the cardio-vascular complications of patients with type 2 Diabetes Mellitus (T2DM) are the most clinically significant, establishing early signs of atherosclerosis is of utmost importance for the prognosis

Purpose
To compare the significance of CASP and of carotid echo-tracking parameters as early signs of atherosclerosis in patients T2DM without cardio-vascular disease

Patients and methods
100 patients with T2DM without overt cardio-vascular diseases and 30 healthy age- and sex-matched controls were included in the study and examined for PWVβ, β-stiffness index, arterial compliance (АС), augmentation index (AI), Peterson’s modulus (Ep) of right CA with Aloka Hitachi Prosound α7. CASP was determined with Caspal A-pulse CASP-AL device. Patients with atrial fibrillation and increased blood pressure were excluded from the study. Results: Тhe mean values of CASP in T2DM were 126.4 mmHg vs 125.7 mmHg in controls (p = 0.84). PWVβ was increased in patients compared to controls: 7.42m/s vs 6.4m/s, p = 0.001. The same changes were found in β-stiffness index - 10.4 vs 7.7 (p = 0.001), AI - 13.3 vs 19.8 9 (p = 0.009), and Ep - 151.3 vs 112.1 (p = 0.001). There was no significant difference in АС - 0.77 vs 0.98 (p = 0.11). There was a mild correlation between the CASP and carotid stiffness indices (Table 1).

Conclusions
Parameters of local arterial stiffness of carotid artery are earlier signs of subclinical atherosclerosis than CASP in patients with T2DM without cardio-vascular disease. One-point echo tracking is a useful non-invasive and easy to perform novel ultrasound method.
Table 1 PWV(L) AC(L) PWV(R) Ep(R) AC(R) AI(R) r p r p r p r p r p r p CASP 0.222 0.045 -.295 0.007 .286 0.011 .273 0.015 -0.214 0.05 .256 0.023 L-left CA, R-right CA
COVID-19 related thrombi in ascending and descending thoracic aorta with peripheral embolization: a case report
Authors: Buikema Jan W , Asselbergs Folkert W , Tekstra Janneke 
Published: February 2021

Abstract

Background
COVID-19 (severe acute respiratory syndrome coronavirus 2) infected patients have increased risk for thrombotic events, which initially may have been under recognized. The existence of cardiovascular emboli can be directly life threatening when obstructing the blood flow to vital organs such as the brain or other parts of the body. The exact mechanism for this hypercoagulable state in COVID-19 patients yet remains to be elucidated.

Case summary
A 72-year-old man critically ill with COVID-19 was diagnosed with a free-floating and mural thrombus in the thoracic aorta. Subsequent distal embolization to the limbs led to ischaemia and necrosis of the right foot. Treatment with heparin and anticoagulants reduced thrombus load in the ascending and thoracic aorta.

Discussion
One-third of COVID-19 patients show major thrombotic events, mostly pulmonary emboli. The endothelial expression of angiotensin-converting enzyme-2 receptors makes it feasible that in patients with viraemia direct viral-toxicity to the endothelium of also the large arteries results in local thrombus formation. Up to date, prophylactic anticoagulants are recommended in all patients that are hospitalized with COVID-19 infections to prevent venous and arterial thrombotic complications.
ST-segment elevation in patients presenting with COVID-19: case series
Authors: Saririan Mehrdad , Armstrong Richard , George Jon C , Olechowski Bartosz , O’Connor Stephen , Byrd James Brian , Chapman Andrew R 
Published: February 2021

Abstract

Background
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the now pandemic disease, coronavirus disease (COVID-19). A number of reports have emerged suggesting these patients may present with signs and symptoms consistent with ST-segment elevation myocardial infarction without coronary artery occlusion.

Case summary
We report an international case series of patients with confirmed COVID-19 infection who presented with suspected ST-segment elevation myocardial infarction. Three patients with confirmed COVID-19 presented with electrocardiogram criteria for ST-segment elevation myocardial infarction. No patient had obstructive coronary disease at coronary angiography. Post-mortem histology in one case demonstrated myocardial ischaemia in the absence of coronary atherothrombosis or myocarditis.

Discussion
Patients with COVID-19 may present with features consistent with ST-segment elevation myocardial infarction and patent coronary arteries. The prevalence and clinical outcomes of this condition require systematic investigation in consecutive unselected patients.
The clot thickens: role of mechanical thrombectomy in intermediate to high-risk pulmonary embolism in the peri-operative setting—a case report
Authors: Planek Maria Isabel Camara , Hoster Clay H , Vij Aviral , Attanasio Steve 
Published: February 2021

Abstract

Background
European Society of Cardiology (ESC) recommends catheter-directed thrombectomy for management of high-risk pulmonary embolism (PE) with contraindications to thrombolytics or in patients that have failed thrombolytic therapy, as well as intermediate-risk PE with haemodynamic deterioration. In this case report, the role of catheter-directed mechanical thrombectomy is highlighted in the urgent peri-operative setting.

Case summary
A 71-year-old female presented with 10 days of progressive lower extremity weakness and was found to have malignant cord compression along with incidental saddle, intermediate–high-risk PE that extended to all lobes on chest computed tomography. Given the intermediate to high-risk PE with acute cor pulmonale, urgent need for surgery, and risk of haemodynamic collapse upon induction of general anaesthesia, the decision was made to proceed with urgent percutaneous treatment of the PE. Percutaneous catheter-directed thrombectomy was successfully performed. The patient returned to the intensive care unit in stable condition and was able to then receive urgent cord decompression and further treatment for malignancy with no complication.

Discussion
In this case, single-session thrombectomy resulted in rapid reduction of pre-operative cardiopulmonary risk by alleviating the right ventricular strain, allowing urgent cord decompression surgery to proceed with optimized haemodynamics, no bleeding events, and no further oxygen requirements. While peri-operative risk stratification for cardiovascular outcomes is well established in current guidelines, there are no clear guidelines for peri-operative risk stratification in the setting of pulmonary embolism. The importance of the multidisciplinary PE Response Team is thus emphasized, as well as the importance of continuous evaluation of clinical decompensation in PE.
Transient bilateral chorea secondary to digoxin toxicity in a female with acute kidney injury: a case report
Authors: Mannion James , Tariq Samreen , Owens Patrick 
Published: February 2021

Abstract

Background
Chorea secondary to digoxin toxicity is rare, with only three published cases describing the phenomenon. We report the case of a 78-year-old female presenting with intermittent vomiting and diarrhoea for 4 weeks. She had a history of chronic kidney disease and digoxin use for atrial fibrillation.

Case summary
A 78-year-old lady presented to the emergency department with a 4-week history of intermittent vomiting and diarrhoea. These symptoms commenced after a course of antibiotics prescribed by her general practitioner for a urinary tract infection. Her admission electrocardiogram demonstrated atrial fibrillation at a rate of 32, with evidence of digitalis toxicity. Her creatinine was 396 µmol/L (44–80 µmol/L) with digoxin level 8.1 nmol/L (0.77–1.5 nmol/L). Initially, treatment was with digoxin-specific antibody (FAB) and fluid resuscitation. Within 24 h, she developed transient head, neck, and bilateral upper limb chorea. Review of medications revealed no other likely causative agent. Neuroimaging showed no new ischaemia, but stable established bilateral infarcts of the basal ganglia. Haloperidol 0.5 mg twice daily was commenced. Three days later as digoxin levels normalized, the chorea resolved entirely without recurrence.

Discussion
We have identified three reported cases of digoxin-induced chorea. Our case resembles two of the published cases where a transient bilateral chorea, associated with digitalis toxicity and resolving within a few days of normalization of digoxin levels was demonstrated. There were no other focal neurological signs or symptoms. It has been postulated that an alteration to dopaminergic neuronal activity is a potential mechanism, as digoxin also demonstrates neuropsychiatric side effects such as psychosis and depression.
Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review
Authors: Whitelaw Sera , Pellegrini Danielle M , Mamas Mamas A , Cowie Martin , Van Spall Harriette G C 
Published: February 2021

Abstract
Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n = 7) and a poor internet connection (n = 7). Six studies reported clinician-level barriers, which included increased workload (n = 4) and a lack of integration with electronic medical records (n = 3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n = 10) and personalized technology (n = 6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that improved efficiency (n = 3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.
Does rainfall variability explain low uptake of agricultural credit? Evidence from Ethiopia
Authors: Abay Kibrom A , Koru Bethelhem , Chamberlin Jordan , Berhane Guush 
Published: February 2021

AbstractCredit markets are key instruments by which liquidity-constrained smallholder farmers may finance productive investments. However, the documented low demand and uptake of agricultural credit by smallholder farmers in sub-Saharan Africa pose challenges for energizing rural transformation in the region. In this paper, we investigate the impact of rainfall uncertainty—a major source of production risk—on the uptake of credit by rural farm households in Ethiopia. We further examine whether rainfall uncertainty explains credit rationing among those households not participating in rural credit markets. We find that rainfall variability discourages the uptake of agricultural credit. We also find that rainfall variability is associated with credit risk rationing, expressed as low demand for agricultural credit. We show that our findings are robust to alternative ways of constructing rainfall variability (inter-annual or inter-seasonal) and a battery of robustness checks. For instance, we show that rainfall variability is a strong predictor of credit uptake in rural areas while less relevant in urban areas. We also document heterogeneous responses to rainfall variability; those households living in the arid and semi-arid lands of Ethiopia, which are believed to be more vulnerable to recurrent weather shocks, are more responsive to rainfall variability in terms of reduced uptake of agricultural credit. Our results highlight the impacts of uninsured production risk on the demand for agricultural credit and hence smallholder agricultural investments. Our findings suggest the importance of interventions aimed at relaxing smallholders’ credit rationing while also reducing their production risk.
Residual cardiovascular risk reduction guided by lifetime benefit estimation in patients with symptomatic atherosclerotic disease: effectiveness and cost-effectiveness
Authors: Hageman Steven H J , Dorresteijn Jannick A N , Bots Michiel L , Asselbergs Folkert W , Westerink Jan , van der Meulen Miriam P , Mosterd Arend , Visseren Frank L J ,   the UCC-SMART Study Group, Asselbergs F W , Nathoe H M , de Borst G J , Bots M L , Geerlings M I , Emmelot M H , de Jong P A , Leiner T , Lely A T , van der Kaaij N P , Kappelle L J , Ruigrok Y M , Verhaar M C , Visseren F L J , Westerink J , Asselbergs F W , Nathoe H M , de Borst G J , Bots M L , Geerlings M I , Emmelot M H , de Jong P A , Leiner T , Lely A T , van der Kaaij N P , Kappelle L J , Ruigrok Y M , Verhaar M C , Visseren F L J , Westerink J 
Published: February 2021

Abstract

Aims
To determine the (cost)-effectiveness of blood pressure lowering, lipid-lowering, and antithrombotic therapy guided by predicted lifetime benefit compared to risk factor levels in patients with symptomatic atherosclerotic disease.

Methods and results
For all patients with symptomatic atherosclerotic disease in the UCC-SMART cohort (1996–2018; n = 7697) two treatment strategies were compared. The lifetime benefit-guided strategy was based on individual estimation of gain in cardiovascular disease (CVD)-free life with the SMART-REACH model. In the risk factor-based strategy, all patients were treated the following: low-density lipoprotein cholesterol (LDL-c) &lt; 1.8 mmol/L, systolic blood pressure &lt;140 mmHg, and antithrombotic medication. Outcomes were evaluated for the total cohort using a microsimulation model. Effectiveness was evaluated as total gain in CVD-free life and events avoided, cost-effectiveness as incremental cost-effectivity ratio (ICER). In comparison to baseline treatment, treatment according to lifetime benefit would lead to an increase of 24 243 CVD-free life years [95% confidence interval (CI) 19 980–29 909] and would avoid 940 (95% CI 742–1140) events in the next 10 years. For risk-factor based treatment, this would be an increase of 18 564 CVD-free life years (95% CI 14 225–20 456) and decrease of 857 (95% CI 661–1057) events. The ICER of lifetime benefit-based treatment with a treatment threshold of ≥1 year additional CVD-free life per therapy was €15 092/QALY gained and of risk factor-based treatment €9933/QALY gained. In a direct comparison, lifetime benefit-based treatment compared to risk factor-based treatment results in 1871 additional QALYs for the price of €36 538/QALY gained.

Conclusion
Residual risk reduction guided by lifetime benefit estimation results in more CVD-free life years and more CVD events avoided compared to the conventional risk factor-based strategy. Lifetime benefit-based treatment is an effective and potentially cost-effective strategy for reducing residual CVD risk in patients with clinical manifest vascular disease.
Photoprotection habits, attitudes and knowledge among school communities in the Costa del sol (Spain)
Authors: Blázquez-Sánchez N , Rivas-Ruiz F , Bueno-Fernández S , Fernández-Morano M.T , Arias-Santiago S , Rodríguez-Martínez A , DeCastro-Maqueda G , DeTroya-Martín M 
Published: February 2021

Abstract

Background
Scholar photoprotection campaigns are among the most effective strategies for preventing skin cancer. Analysis of the target population constitutes a valuable starting point for the implementation of primary prevention strategies. Our aim is to study photoprotection habits, attitudes and knowledge among a Spanish school community.

Methods
Descriptive cross-sectional study targeting schoolchildren, parents and teachers at 20 schools in the area of the Costa del Sol Health Agency in southern Spain. Two population-specific, validated questionnaires were used: the CHRESI (for children aged 0–10 years) and CHACES Questionnaire(for adults and adolescents aged &gt; 11 years). We collected demographic data, skin colour, skin phototype, sunburn episodes, sun exposure and photoprotection practices, attitudes and knowledge.

Results
1728 questionnaires were analyzed (22% parents, 14.5% teachers, 44.8% adolescents and 18.6% children). The average ages were 8 years (children), 16 years (adolescents), 39 years (teachers) and 42 years (parents). Globally, the predominant features were: male sex (52%), Spanish nationality (92%) and phototypes II–III (61%). Children, followed by adolescents, reported the highest exposure to the sun, both in frequency and in duration. Adolescents had the higher rate of sunburn (75%), followed by parents/teachers (54.1%) and children (44.1%). Children and their parents were the most likely to adopt photoprotection measures, while adolescents presented more risky attitudes. Knowledge regarding photoprotection was acceptable (6.9/10).

Conclusions
This study highlights the need to improve photoprotection knowledge, habits and attitudes among our target population. Scholars, parents and teachers in our area should be addressed in campaigns to promote healthy sun exposure habits, thus reducing skin cancer-related morbidity and mortality in this region.
The extra costs associated with a cognitive impairment: Estimates from 15 OECD countries
Authors: Morris Zachary A , Zaidi Asghar , McGarity Stephen 
Published: February 2021

Abstract

Background
The objective of this study is to estimate the additional income required of a household containing an older adult member living with a cognitive impairment (CI) consistent with dementia (CID).

Methods
Secondary analyses were provided of data from the Survey of Health Aging and Retirement in Europe incorporating data of adults’ age 65 years old and older across 15 OECD countries in 2013. We also analyzed longitudinal data of a smaller subset of respondents interviewed in a previous survey wave in 2011. We used OLS regression and the Standard of Living (SOL) approach to estimating the extra costs of disability.

Results
Households containing a member experiencing a CID are estimated to require 48% more income to maintain their SOL compared to similar households not including an adult with CID. Those with CI without dementia are estimated to have lower costs (14%). Those with longer-term CID are estimated to incur greater costs than those with a more recent onset of a CI. The extra costs are estimated to be lower in countries with more formalized public long-term care arrangements. We further identified out of pocket costs for home care services as a likely expenditure item driving these cost estimates.

Conclusions
Results suggest that caring for a person living with dementia can lead to considerable expenses. These additional direct costs associated with dementia provide insights for households in anticipating the risks of financial insecurity as they grow older. Future research is needed to identify the consumption items driving these estimates.