bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Features of Systemic Juvenile Idiopathic Arthritis in Patients With Congenital Heart Disease
Authors: Aires Barbara Pontes , Wobma Holly , Samad Aaida , Chandler Mia T. , Chang Margaret H. , Dedeoglu Fatma , Fishman Martha P. , Klouda Timothy , Levin Jonathan , Halyabar Olha , Saleeb Susan F. , Tworetzky Wayne , Son Mary Beth F. , Newburger Jane W. , Casey Alicia , Henderson Lauren A. 
Published: June 2024

ObjectiveTo describe the clinical features of patients with congenital heart disease (CHD) who subsequently developed systemic juvenile idiopathic arthritis (sJIA).MethodsWe conducted a retrospective review of patients diagnosed with CHD and sJIA at our institution. Detailed clinical, laboratory, and radiographic data were collected from the medical record and reviewed with each patient’s primary medical team.ResultsFive patients with sJIA and CHD were identified. Each child had a unique cardiac anatomy, but all the patients required surgical repair during the first year of life. Four children had thymectomies at the time of cardiac surgery. Classic signs of sJIA such as fever (n = 5), rash (n = 5), and arthritis (n = 4) developed after surgical intervention in all the patients. The individuals in this cohort displayed risk factors associated with severe sJIA, including disease onset before 2 years of age (n = 5), elevated interleukin 18 levels (n = 5), baseline eosinophilia prior to initiation of biologic disease-modifying antirheumatic drugs (n = 4), and positivity for HLA-DRB1*15:01 alleles (n = 4). Macrophage activation syndrome (MAS) occurred in 3 patients and sJIA-associated lung disease (sJIA-LD) was identified in 4 patients. Two children died from complications of their cardiac and/or pulmonary disease.ConclusionWe identified an association between CHD and severe forms of sJIA. Although these findings will need to be confirmed in larger, multicenter cohorts, the results highlight the importance of considering a diagnosis of sJIA in children with CHD and remaining vigilant for complications such as MAS and sJIA-LD.
Incidence, Predictors, and Outcome of Significant Atrioventricular Block in Acute Coronary Syndrome − A Study from Major Center in North-Eastern India
Authors: Dutta Bornali , Iqbal Farhin , Farooqui Waseem 
Published: June 2024

Background:
Indian studies on significant atrioventricular (AV) block in entire spectrum of acute coronary syndrome (ACS) and its relation with clinical outcome are limited.

Aims:
The aim of this study is to determine the incidence, clinical predictor, and outcome of significant AV block complicating entire spectrum of ACS.

Methods:
All patients presenting with ACS from June 2017 to December 2018 were included in the study. The study population was divided into case and control groups based on the presence of significant AV block, either at admission or during hospitalization. The baseline clinical characteristics, mode of presentation, clinical course in the hospital, treatments in hospital, and complications related to the ACS and its treatment were analyzed between case and control groups. The inhospital and 30 day outcome was also analyzed.

Results:
A total of 1001 patients with ACS were included. One hundred and twenty-five patients of ACS with significant AV block comprised the study population (cases) and the rest 876 patients with ACS without significant AV block comprised the control population. The overall incidence of significant AV block was 12.48%. Patients with significant AV block had higher incidence of diabetes (40% vs. 20.77%, P-0.001), hypertension (36.8% vs. 20.89%, P-0.002), and history of smoking (57.6% vs. 34.2%, P-0.0001). On clinical presentation, patients with significant AV block had lower mean heart rate and higher killip class. Inferior wall myocardial infarction (44.4% vs. 22.8%, P-0.0001) was higher in cases, whereas anterior wall myocardial infarction (25.6% vs. 43.3% P-0.001) and unstable angina (4% vs. 10.2%, P-0.02) were higher in controls. Percentage of patients undergoing temporary pacemaker implantation or percutaneous coronary intervention during hospitalization was higher in cases. At 30 days, mortality was significantly higher among cases (24% vs. 8.1%, P-0.0001).

Conclusion:
Our data represent the first reported study on significant AV block in entire spectrum of ACS in North-eastern India and has noted the high incidence of significant AV block in our population and is associated with a worse short-term outcome.
Patients’ Hospital Ratings Correlate with 30-Day Mortality and Readmission Rates following Hospitalization for Both Myocardial Infarction and Coronary Artery Bypass Graft Surgery
Authors: Lien Irvin Chi-Yang 
Published: June 2024

Introduction:
Coronary heart disease is the leading cause of mortality and morbidity world-wide. Mortality and readmission rates following both myocardial infarction (MI) and coronary artery bypass graft surgery (CABG) have improved with advancements in medicine and standardization of treatment, however these improvements have plateaued in recent years. The purpose of this study was to investigate whether overall hospital ratings can indicate patterns of mortality rate and readmission rate following hospitalization for MI and CABG.

Methods:
Public data from the Centers for Medicare & Medicaid Services was utilized in the study. The 30-day risk standardized mortality rate (RSMR) and readmission rate (RR) following both MI and CABG for hospitals were matched with their overall hospital rating based off the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Hospitals were grouped based on their hospital ratings and their 30-day RSMR and RR were averaged within each group. A Pearson correlation was used to assess for correlation between hospital ratings and their 30-day RSMR and RR for both MI and CABG.

Results:
There was a strong negative correlation between hospital ratings and their averaged 30-day RSMR for both MI (R= -0.84; P < 0.0001) and CABG (R = -0.70; P < 0.0037). Similarly, there was a strong negative correlation between hospital ratings and their averaged 30-day RR for MI (R = -0.81; P < 0.0002) and CABG (R = -0.83; P < 0.0001). There was no significant difference between any group.

Discussion:
The correlation between hospital rating and the 30-day RSMR and RR following both MI and CABG suggest that hospital ratings may be one among many factors that can impact patient outcome for MI and CABG. However, this correlation is only present when the 30-day RSMR and RR are averaged. There are likely multiple confounding variables and improving hospital ratings alone would not be expected to significantly improve patient outcomes.

Conclusion:
Hospital ratings which incorporates patients’ perspective of good communications among hospital staff, timely staff responsiveness, quiet/clean hospital environment, and thorough discharge planning, may be factors that contribute to patients’ 30-day RSMR and RR for both MI and CABG.
Atherosclerotic Cardiovascular Disease Burden in Ghana: A Scoping Review
Authors: Agyekum Francis , Akumiah Florence 
Published: June 2024

Background:
The global burden of atherosclerotic cardiovascular disease (ASCVD) is high. Documented data on the burden of ASCVD and its mortality in low- and middle-income countries are however limited particularly in Ghana. This study aims to identify the research gaps related to the ASCVD burden in Ghana to provide the recommendations to guide future research.

Materials and Methods:
We undertook a scoping review of ASCVD, comprehensively searching databases to identify all English-published articles on ASCVD and risk factors in Ghana from inception to 2021. Data on the study characteristics and key findings were independently extracted by two authors. We used a charting approach to synthesize and interpret the data.

Results:
We included 22 articles in this scoping review out of a total of 160 articles identified. There is a broad spectrum of conditions that are included under ASCVD. The most commonly included conditions were ischemic stroke, coronary artery disease, peripheral artery disease, and aortic disease.

Conclusion:
This scoping review has shown that ASCVD poses a considerable burden in the Ghanaian population, mostly driven by ischemic stroke. There is a need for an intensified effort by stakeholders, through research and policy, to identify and address the factors driving ASCVD to rise and prioritize prevention.
Premature Coronary Artery Disease in Young Indians
Authors: Vijaykumar Reddy J R , Patil Rahul S , Shetty Laxmi H , Manjunath C N 
Published: June 2024

Background:
Cardiovascular diseases (CVDs) are on the rise globally. India, in spite of housing the youngest population, has now been termed the CVD capital of the world. Several independent studies have shown association between low levels of Vitamin D, insulin resistance, and low testosterone levels and coronary artery disease (CAD). However, the presence of this hormonal triad in premature CAD patients in India has not been studied. Therefore, we aimed to explore the role of this hormonal triad in CAD in young Indians.

Methods:
This was a prospective, case–control, study conducted at a tertiary care center in India. Premature CAD patients were enrolled as cases and healthy individuals were enrolled as controls. Demographic, behavioral, anthropometric and body composition, physiological, and biochemical parameters were recorded/assayed as per standard protocols.

Results:
A total of 644 individuals were enrolled in the study. Among them, 344 belonged to the case group and 300 to the control group. The mean age did not differ significantly between cases (32.1 ± 5.6 years) and controls (32.5 ± 5.0 years). Significantly lower levels of Vitamin D levels (P = 0.01) and serum insulin (P < 0.001) were observed in the case group compared to the control group. In males, no significant difference was observed between the two groups in terms of serum testosterone level (P = 0.075).

Conclusion:
Higher fasting insulin levels may be a reliable indicator of premature CAD. Vitamin D levels may not reliably predict premature CAD because 70%–90% of Indians are deficient of Vitamin D. Testosterone levels in females, but not in males, may be a reliable predictor for the same. However, larger studies are required to validate these findings.
Reduction in Health-related Quality of Life during Coronavirus Disease 2019 Pandemic in Children with Congenital Heart Disease – Findings from Self and Proxy Report
Authors: Brudy Leon , Meyer Michael , Oberhoffer-Fritz Renate , Ewert Peter , Müller Jan 
Published: June 2024

ABSTRACT

Objective:
The aim of this study was to determine how the coronavirus disease 2019 (COVID-19) pandemic affects the health-related quality of life (HRQoL) of children and adolescents with congenital heart disease (CHD), as well as how the parents perceive the HRQoL of their children.

Patients and Methods:
HRQoL was assessed by the KINDL® questionnaire during the COVID-19 pandemic and compared to recent questionnaire data of children of the Functional Outcome in children and adolescents with congenital heart disease (FOOTLOOSE) study. From May 27 to June 29, 2020, 160 children with various CHD (15.2 ± 2.5 years, 62 girls, age range: 10–18 years) completed this re-assessment of HRQoL.

Results:
HRQoL in children with CHD was significantly lower during the COVID-19 pandemic compared to before in total KINDL® score (by −2.1 ± 12.3, P = 0.030), and the subscales emotional well-being (by −5.4 ± 1.2, P < 0.001) and friends (by −4.5 ± 1.7, P = 0.009). Parents of children with CHD rate the HRQoL in total KINDL® score (mean difference: 3.9 ± 1.2, P = 0.002), and the subscales family (mean difference: 8.8 ± 1.7 standard estimate error [SEE], P < 0.001) and friends (mean difference: 7.6 ± 2.2 SEE, P < 0.001) even worse than their children. Only moderate degree of agreement was found between most of the sub-categorical HRQoL assessment of children with CHD and their parents.

Conclusions:
The COVID-19 pandemic had a negative impact on HRQoL in children and adolescents with CHD and their families. The psychological concerns of children with CHD and their families need special consideration by health-care providers during the COVID-19 pandemic.
Assessment of Physical Inactivity Level, Work-related Stress, and Cardiovascular Disease Risk among Nigerian University Staff Members
Authors: Ogunyemi Suraj Adefabi , Awotidebe Taofeek Oluwole , Fasakin Olufesola Motunrayo , Ademoyegun Adekola Babatunde , Adebayo Rasaaq Ayodele , Abudu Funmilayo Rebecca , Akintomide Anthony Olubunmi , Odunlade Adekola John , Adesokan Oluwatobi Joseph , Adedoyin Rufus Adesoji 
Published: June 2024

ABSTRACT

Background:
Sedentary behavior and mounting workload among university staff may increase risk of chronic diseases. However, information on the link between physical inactivity (PIA), work-related stress (WRS) and cardiovascular disease (CVD) risk is controversial. This study assessed and determined the association between PIA, WRS and CVD risk among university staff in Nigeria.

Methods:
This cross-sectional study involved 500 teaching and nonteaching staff of a Nigerian university using purposive sampling method. PIA level and WRS were assessed using the International Physical Activity Questionnaire and a modified International stress questionnaire, respectively. CVD risk was assessed using the Framingham Heart study questionnaire. Data was analyzed using descriptive and inferential statistics. Alpha level was set at P < 0.05.

Results:
The prevalence of PIA, WRS, and CVD risk were 37.6%, 33.3%, and 61.0%, respectively. Age and high income were significantly associated with PIA in both teaching and nonteaching staff (P < 0.05). In both the groups, older adults and female participants were almost thrice more likely odds ratio (OR) =2.85 (confidence interval [CI] =2.58–3.12) and OR = 2.98 (1.95–5.72) at CVD risk, respectively. Furthermore, individuals with WRS score ≥ 14 (OR = 2.14; CI = 1.14-4.29), and with obesity (OR = 4.20; CI = 2.58-6.25) were more than twice likely to present with CVD risk. The variability of the regression model for the prediction of CVD risk was 13.0% (R
2 = 0.130).

Conclusion:
The prevalence of PIA and work-related stress among Nigerian university staff is high and is associated with high CVD risk. Strategies in reducing PIA and WRS are essential for mitigating CVD risks among Nigerian University staff.
Spectrum of Coronary Artery Disease in Seropositive Syphilis Patients in the Modern Era
Authors: Harsha Mullusoge Mariappa , Hegde Srinidhi , Mahadevaiah Ashwini , Krishnappa Santhosh , Sadananda Kanchanahalli Siddegowda , Nanjappa Manjunath Cholenahally 
Published: June 2024

Context:
Cardiovascular manifestations of tertiary syphilis include aortitis, aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. There are few reported cases of coronary aneurysms and coronary dissection. However, in the modern era of antibiotics, classic manifestations are rarely seen. We intend to study the spectrum of coronary artery disease in seropositive syphilis patients undergoing cardiac catheterization.

Subjects and

Methods: Coronary angiogram of 150 patients seropositive for syphilis from March 2019 to April 2020 was reviewed. Seropositive for both Venereal Disease Research Laboratory and Treponema Pallidum Hemagglutination Assay tests were an essential inclusion criterion. Prevalence of left main stenosis, coronary ostial stenosis, aneurysms, dissections, and other features were studied and compared to standard prevalence in the general population undergoing coronary angiogram.

Results:
Mean age was 56 years and 109 (73%) were male. Thirty-three percent were smokers, 39% were diabetic, 45% hypertensive, and 5% had prior stroke. We noticed left main stenosis in 8%, isolated ostial left main stenosis in 1.3%, spontaneous coronary artery dissection in 0.7%, and coronary aneurysm and ectasia in 4%; a similar prevalence to the general population as compared with earlier trials.

Conclusion:
In the present study, there was no significant increase in aorto-ostial stenosis, coronary aneurysm, or coronary dissection in seropositive syphilis patients. The classic manifestations of tertiary syphilis are rare in the modern era. All syphilis patients should be treated with proper antibiotics, as a case of giant aneurysm post left main ostial stenting was noticed in an untreated patient.
Single-center Experience of Slow Thrombolysis in Stuck Mechanical Mitral Valve in India
Authors: Guleria Vivek Singh , Sharma Prafull , Keshavamurthy G , Bharadwaj Prashant , Datta Rajat 
Published: June 2024

ABSTRACT

Introduction:
India is the rheumatic heart disease (RHD) capital of the world. It is home to 40% of all people of RHD. Many of these patients undergo valve replacement surgeries in our country. These patients present with prosthetic heart valve thrombosis (PHVT) as the international normalized ratio (INR) is not monitored due to several restraints. Many precious lives are lost due to the scarcity of cardiac surgery centers and the high mortality associated with redo procedures. Various international studies have proved the efficacy and low complication rate of slow thrombolysis with tissue plasminogen activator (tPA) compared to surgery in PHVT. Most Indian studies have used streptokinase for PHVT and data on tPA are lacking.

Materials and Methods:
Twenty-one patients with prosthetic mechanical mitral valve presenting with dyspnea, a high gradient across the prosthetic valve, and decreased leaflet motion were included in the study. As it is not always possible to differentiate pannus from a thrombus and association of some degree of thrombosis even in pannus, we offered thrombolysis as the first line of treatment to all patients. Slow thrombolysis with 25 mg of tPA over 6 h followed by unfractionated heparin for 18 h was given, and thereafter, patients were reassessed for thrombolytic success or complications if any. A total four sessions of thrombolysis were given, and thereafter, patients with failed thrombolysis were referred for valve replacement surgery.

Results:
Out of 21 patients, 67% were females. The mean age of patients was 54.33 ± 10.6 years. Fifty-seven percent of patients were in the New York Heart Association (NYHA) III/IV. Atrial fibrillation was present in 62% of patients. The mean time of interval from the time of valve surgery to the time of thrombosis was 80 ± 57 months and the mean INR was 1.43 ± 0.4. The total success rate was 71% in this study, 9% had complications, and 19% had failed thrombolysis and underwent redo mitral valve replacement. The mean dose of tPA was 56.58 mg in this study and a mortality rate of 4%. Age had no effect on the success of thrombolysis. The presence of sinus rhythm, NYHA class I/II status, EF more than 40%, and mean gradient <20 mmHg was associated with a higher likelihood of success.

Conclusion:
In this study of PHVT in Indian patients, slow (6 h) infusion of low-dose (25 mg) tPA proves to be associated with a low complication rate, low mortality, and a promising success rate. This regimen can be offered to PHVT patients in our peripheral centers where cardiac surgical facilities are not readily available.
Clinical Presentation, Treatment, and In-hospital Outcomes of ST-Segment Elevation Myocardial Infarction
Authors: Das Chandra Kumar , Mishra Animesh , Kapoor Manish , Malviya Amit , Saha Swapan 
Published: June 2024

Background:
India has a substantial burden of acute coronary syndromes, yet awareness regarding treatment and outcome of these conditions is limited. Thus, the present study aimed to document the characteristics, treatments, outcomes, and reasons for prehospital delay in patients with ST-segment elevation myocardial infarction (STEMI) admitted to a tertiary care hospital in North East India.

Materials and Methods:
A prospective, hospital-based, observational study was conducted at a tertiary care hospital in North East India between December 2016 and November 2017. All consecutive patients presenting with electrocardiographic evidence of STEMI were included in the study.

Results:
A total of 100 patients were assessed. Of these patients, 84 (84.0%) were male and 59 (59.0%) were urban residents. Smoking, hypertension, and dyslipidemia were the most common risk factors observed in 71 (71.0%), 55 (55.0%), and 43 (43.0%) patients, respectively. Anterior wall myocardial infarction was the most frequent type of STEMI observed in 59 (59.0%) patients. Only 54 (54.0%) patients reached the hospital within the window period. The average time to reach the hospital was 355 min. Thirty-three (33.0%) patients underwent thrombolysis, while 14 (14.0%) patients underwent primary percutaneous coronary intervention. Inhospital mortality occurred in 5 (5.0%) patients.

Conclusion:
Most patients were in the 60–69 years' age group, urban residents, and smokers. They received late medical care and received emergency therapies less often. In most cases, prehospital delay was due to patient inability to recognize symptoms at onset. Strategies to curb tobacco use, decrease prehospital delay, and improve urgent care could reduce morbidity and mortality in this patient subset.
Effect of White Blood Cell Indices and Glycemia on Inhospital Prognosis of ST-Segment Elevated Myocardial Infarction
Authors: Jadhav Dnyaneshwar V , Muley Dnyaneshwar , Deshmukh Shweta 
Published: June 2024

Background:
Early risk stratification is recommended in daily clinical practice to predict adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Complete blood count and blood glucose analysis is routinely performed on admission. Hence, this study was undertaken to find out the predictive value of white blood cell (WBC) indices and glycemia to know adverse outcomes in STEMI.

Methods:
In an observational study conducted between December 2015 and October 2018 at a tertiary center, 400 patients with acute STEMI were included.

Results:
We had 400 patients of STEMI. In this study, mean total leukocyte count (TLC), total neutrophil count (TNC), neutrophil-to-lymphocyte ratio (NLR), and plasma glucose were higher in those with complications (13,449.8/mm3, 10,460.5/mm3, 5.20 and 180.8 mg%) than those without complications (11,318.3/mm3, 8581.9/mm3, 4.15, and 151.1 mg%) (P < 0.05). The cutoff point of TLC >13 × 1000 cells/mm3 had a sensitivity of 73.5% and specificity of 63% in predicting postmyocardial infarction mortality (area under the curve = 0.68,P< 0.001). Patients with acute hyperglycemia (≥140 mg%) had higher incidence of hypotension (31.12% vs. 17.64%,P< 0.05), left ventricular failure (32.14% v/s. 21.1%,P< 0.05), ventricular arrhythmias (13.26% vs. 6.86%,P< 0.05), and higher inhospital mortality (P = 0.0001). Multivariate analysis predicting inhospital mortality as dependent variable TLC >13 × 1000 cells/mm3, TNC >10.5 × 1000 cells/mms3, NLR ≥5.20, and plasma glucose >140 mg/dl were the variable found to be statistically significant (P < 0.05).

Conclusion:
The WBC indices (TLC, TNC, and NLR) and plasma glucose on admission are independent predictors of major cardiovascular events and inhospital mortality in STEMI.