bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical manifestation and impact on management of acute coronary syndrome during covid-19 pandemic, lessons learnt from a tertiary care
Authors: Subburaja T , Sambasivam K A , Radhika R , Sankara Thiagarajan P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The World Health Organization first characterized COVID-19 as a ongoing pandemic since 12th March 2020. Since then, mitigation plans including vaccinations are on the run globally. During this pandemic several restrictions worldwide are being followed , which had major impact on acute coronary syndrome presentation due to various factors.At our tertiary cardiac care centre we analyzed the consecutive acute coronary syndrome admissions and its impact in the management during the pandemic lockdown .

Purpose
Our study aimed in identifying the salient clinical manifestations and impact on the management of Acute Coronary Syndrome (ACS) during the 1st wave of COVID-19 Pandemic in a tertiary care center to inform future implications/preparedness for ACS care during the revolving Pandemic.

Methods
Clinical profile of patients admitted in our tertiary coronary care unit between March – June 2020 was analyzed. Descriptive statistics was performed, and continuous data were reported as mean ± SD and as percentages.

Results
Among the consecutive 265 patients who were treated in our coronary care unit, mean age of the patients was 58.43 ± 11.366 years and about 81% of them were males. Nearly one third of the patients presented with non-ST elevation MI at the time of diagnosis. Previous history of MI was well pronounced in 63% (N = 169) of the patients with a combined history of hypertension, diabetes, dyslipidemia. A higher proportion of patients presented with mild to moderate left ventricular dysfunction (N = 123, 46.6%). Higher rates of patients needed thrombolysis care (68%) where thrombolysis with ELAXIM (N = 41), STK (N = 22) were commonly used in the process. About 96.2% of the patients presented with delayed window period of &gt;48 hours and about 75% of them underwent ADHOC PCI procedure as the next level of management during admission. Coronary angiogram findings were suggestive of a triple vessel disease in 36% of the patients with previous history of coronary interventions with in the last 5 years. Complications of cardiogenic shock requiring IABP(N = 5). and death were very minimal and were seen in patients with previous coronary bypass surgery with in last 5 years (died, N = 2), acute pulmonary thromboembolism (IABP, N = 2) .

Conclusion
We observed patients with late presentation to hospital, covid protocol has increased thrombolysis compared to primary PCI in non covid time with no major bleeding risks in our patients .Most of our patients opted for ADHOC PCI , preexisting coronary artery disease patients presented as triple vessel disease .Though late presentation no significant complication rate noted.Further study would facilitate healthcare planning and preparedness for further COVID waves.
Risk stratification and prognosis in pulmonary arterial hypertension: the Singapore experience
Authors: Teoh J , Yap J L J , Ong Z Y P , Lee J D B , Wen R , Ismail A B , Sewa D W , Phua G C , Fong C H Y , Low A H L , Lim S T , Tan J L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aims & Background: Guidelines recommend the risk stratification of patients with pulmonary arterial hypertension (PAH) at baseline and on follow-up, so as to guide the management and titration of therapy in these patients. This approach has been validated in various pulmonary hypertension registries in the West. We aim to study the value of risk stratification on the prognosis of PAH patients in Asia.

Methods
A retrospective review of all PAH patients from 2002 to 2018 from a single tertiary cardiac centre was performed. Inclusion criteria was the availability of both initial visit and follow-up data. Patients were classified into low-, medium-, and high-risk groups in both initial and follow-up visits based on the variables in the 2015 ESC/ERS PH risk stratification table according to the "score and average" method used by SPAHR and COMPERA registries (total score divided by number of variables assessed and rounded to nearest integer). An average score of 1, 2 and 3 was defined as low, medium and high risk respectively. The primary outcomes was all-cause mortality.

Results
A total of 102 patients (mean age 57 ± 18 years old, 82 females) were included. Survival was significantly affected by PAH subtype and risk profile. On multivariate analysis, baseline risk did not impact on mortality. Follow-up risk stage impacted on prognosis, with significantly poorer prognosis noted in both intermediate- (adj HR 3.12, 95% CI 1.03 – 9.48, p = 0.045) and high-risk (adj HR = 7.84, 95% CI 2.22 – 27.64, p = 0.001) groups. Patients who improved their risk groups to low risk on follow-up had similar survival to stable low-risk patients, but those patients whose risk group worsened on follow-up had significantly worse prognosis (adj HR = 5.44, 95% CI 1.26 – 13.75, p = 0.02).

Conclusion
Risk stratification is useful in prognosticating Asian PAH patients. There is potential survival benefit in optimising treatment to achieve a low-risk profile.
Refined balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: a prospective multicenter registry
Authors: Zhou Y-P , Wei Y-P , Yang Y-J , Peng F-H , Wu B-X , Hong C , Tong Q , Cui X-P , Zhang G-C , Cao Y-S , Wang D-L , Xu X-Q , Jiang X , Jing Z-C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): the National Key Research and Development Program of China
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening disease with a poor prognosis if left untreated. Pulmonary endarterectomy is the standard treatment for CTEPH, but around 40% of CTEPH patients are non-eligible for surgery.
Purpose To investigate the efficacy and safety of refined balloon pulmonary angioplasty (BPA) for inoperable CTEPH in a prospective multicenter registry from China.
Methods We conducted a prospective multicenter cohort study using the data from National Rare Disease Registry System of China. Total 140 consecutive patients with inoperable CTEPH who completed BPA between Jan 2016 and Dec 2020 were enrolled. The key efficacy outcomes were changes from baseline to re-evaluation in mean pulmonary arterial pressure, pulmonary vascular resistance, and six-minute walking distance. The safety outcomes were procedure-related complications. The survival outcome was all-cause mortality.
Results Among the 140 patients who completed BPA, the mean age at diagnosis was 58 ± 14 years and 60.0% were female. At re-evaluation, the least-squares mean change from baseline was -18.3 mm Hg (95% confidence interval [CI], -19.9 to -16.6, P &lt; 0.001) in mean pulmonary arterial pressure, -5.3 Wood U (95% CI, -5.9 to -4.6, P &lt; 0.001) in pulmonary vascular resistance, and 87 meters (95% CI, 74 to 101, P &lt; 0.001) in six-minute walking distance. BPA procedure-related complications occurred in 109 of 650 BPA sessions (16.8%), but severe complications requiring noninvasive positive pressure ventilation only occurred in 4 (0.6%) BPA sessions. During a mean follow-up time of 32 ± 14 months, 4 patients died, including 2 peri-procedural deaths, contributing to the survival rates of 97.8% (95% CI, 93.4 to 99.3) at 1 year and 96.9% (95% CI, 91.9 to 98.8) at 3 and 5 years.
Conclusion Refined BPA appears to be an effective therapeutic option for inoperable CTEPH patients with acceptable safety profiles. Abstract Figure. Images of BPA Efficacy in a Patient Abstract Figure. Efficacy outcomes of BPA
Clinical significance of epicardial fat in suspected angina pectoris: an observational study
Authors: Dadarwal A , Garg N , Kapoor A , Tewari S , Kumar S , Khanna R , Sahu A , Goel P K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Epicardial adipose tissue (EAT) is the visceral fat between pericardium and visceral epicardium and is the source of several endocrine and inflammatory mediators. It also has paracrine affects in the neighboring coronary arteries.

Objective
To evaluate the association of EAT with subclinical atherosclerosis (carotid intima media thickness & flow mediated vasodilation), ultrasonic and anthropometric measures of abdominal fat, metabolic syndrome and coronary artery disease (CAD) concurrently.

Material and methods
Patients who underwent computed tomography (CT) coronary angiography for suspected CAD were prospectively included. All underwent anthropometric measurements, laboratory investigations, ultrasonic measurement of liver fat grade & B-mode hepatorenal ratio, carotid intima media thickness (CIMT), flow mediated vasodilation (FMD), CT measurement of epicardial fat thickness (EFT) & epicardial fat volume (EFV) along with CT coronary angiography. Study population was divided into 2 groups on the basis of presence or absence of CAD and were compared. The relationship between risk factors and presence of CAD was assessed by logistic regression analysis. To define EFT and EFV value predictive of the presence of significant CAD, the area under (AUC) the receiver operating characteristic (ROC) curve was calculated. Correlation between EFT as well as EFV with anthropometric and laboratory parameters, CIMT and FMD were assessed by Pearson correlation coefficient.

Results
Total 54 patients were included in study. Mean age was 54 years, 66% were diabetic and 33% were hypertensive. Mean CIMT, FMD, EFT and EFV were 0.70 + 0.27 cm; 5.64 + 2.64%; 5.51 + 2.50 mm and 60.6 + 28.6 cc, respectively. Total 34 (62.96%) patients were detected to have CAD. EFT as well as EFV were significantly higher in CAD group (3.31 + 2.34 vs 6.24 + 1.91mm; p= &lt;0.001, 72.5 + 22.3 vs 40.4 + 27.1cc; p= &lt;0.001); in patients with metabolic syndrome (83.3 + 18.4 vs 49.2 + 26.1cc; p &lt; 0.001, 7.13 + 1.49 vs 4.16 + 2.32mm; p &lt; 0.001). Both, EFV & EFT were significantly correlated with the abdominal fat, CIMT and FMD. Smoking, age and EFV were the independent predictors for CAD. EFV &gt;31.65cc predicted the presence of CAD (sensitivity 91.25%, specificity 60%, AUC = 0.798, 95% CI = 0.665-0.930) and EFT &gt;2.85mm predicted the presence of CAD (sensitivity 94.1%, specificity 65%, AUC= 0.820, 95% CI= 0.687-0.953).

Conclusions
Epicardial fat is significantly associated with presence of CAD, metabolic syndrome, visceral fat, CIMT and FMD. CT measured epicardial fat may be included with CT based CAD lesion assessment and CT coronary calcium score to screen the patients of suspected angina pectoris. Abstract Figure. Epicardial adipose tissue Abstract Figure. EFV and CAD
Comorbidity and quality of life in older patients with chronic cardiorenal syndrome and obstructive sleep apnea
Authors: Efremova E , Shutov A M , Serov V A , Igonina N V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Comorbidity increases with age, including the presence of cardiovascular disease, chronic kidney disease (CKD) and obstructive sleep apnea (OSA). OSA is considered as a risk factor for the progression of CKD.
The aim of this study was to investigate сomorbidity and quality of life in older patients with chronic cardiorenal syndrome and obstructive sleep apnea.

Materials and methods
80 older patients with stable cardiovascular disease and CKD (43 males, mean age was 67.6 ± 6.1 years) were studied. CKD was diagnosed and classified according to the KDIGO guidelines (2012). OSA was observed according to Clinical Guidelines for Obstructive Sleep Apnea and Insomnia (U.S., 2020). Berlin Questionnaire and Epworth Sleepiness Scale, cardiorespiratory monitoring for screening and diagnosis of OSA were used. Charlson comorbidity index (CCI) was estimated. The patients" quality of life (EQ-5D-5L), the presence of anxiety and depression (Hospital Anxiety and Depression Scale), psychological defense mechanisms were assessed.

Results
Chronic kidney disease was observed in 48 (60%) patientswith stable cardiovascular disease. OSA was first diagnosed in 31 (64.5%) older patients with CKD. Рatients with CKD had a high comorbidity independently of OSA: CCI was 8 (7; 8) points in patients with OSAS and 7 (7; 8) points in patients without OSAS (p = 0.51). There was a direct relationship between CKD and the severity of daytime sleepiness (r = 0.30, p = 0.02), as well as complaints about the quality of sleep (r = 0.31, p = 0.01) in patients with CKD. Severity of anxiety and depressive reactions, disturbance of habitual activity, increased pain and discomfort, decrease QOL index (EQ-5D-5L) in the presence of disturbed sleep quality and daytime sleepiness were observed. With a Older patients with CKD and decrease in the quality of sleep less commonly used mature mechanisms of psychological defense, such as «рrojection» (r = -0.39, p = 0.04) and «rationalization» (r = -0.41, p = 0.03). There was association between the severity of sleep disorders and the tension of the primitive mechanism of psychological defense «regression» (r = 0.41, p = 0.008), which contributes to the impairment of adaptation in older patients with CKD.

Conclusion
Older patients with CKD and OSA have a high comorbidity, including cardiovascular comorbidity. There were no differences in the structure of comorbidity in older patients with chronic cardiorenal syndrome, depending on the presence of OSA. Sleep impairment, daytime sleepiness were associated with the severity of anxiety and depression, a decrease in the quality of life, and maladjustment.
Rapid adoption of electronic health record and health information exchange among assisted living communities, 2010–2018
Authors: Lin Sunny C , Tunalilar Ozcan 
Published: February 2022

Abstract
Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the study period. However, adoption of HIE functions lagged significantly behind EHR functions in both 2010 and 2018 and was accompanied by growing disparities in the adoption of EHR functions among smaller, nonchain, and for-profit communities. To improve the quality of care for this important and growing population, targeted policies are needed to support the adoption of both EHR and HIE functions in ALC.
Liver abscess secondary to fishbone ingestion: case report and review of the literature
Authors: Grayson Niamh , Shanti Hiba , Patel Ameet G 
Published: February 2022

AbstractWe report a rare silent migration of a fishbone into the liver and review the relevant literature. A 56-year-old man presented with a 2-day history of dull epigastric pain and raised inflammatory markers. Computerized tomography scan revealed a 4-cm abscess in the left lobe of the liver, with a linear radio-dense foreign body within the collection. At laparoscopy the hepatogastric fistula was disconnected. The fishbone was retrieved from the liver. Gastrostomy was closed with an omental patch. The patient had an uneventful recovery. Fifty-two cases of liver abscess secondary to enterohepatic fishbone migration were reported with over two-thirds presenting with a left-lobe abscess. There was marked variability in the management of liver abscess in the setting of fishbone migration-summarized in table. We believe that laparoscopic drainage of the abscess and extraction of the foreign body offer control of the source of sepsis and diminishes recurrence, whilst having a low-risk profile.
Predictors of Death, Survival, Need for Intubation, and Need for Oxygen Support Among Admitted COVID-19 Patients of the Veterans Affairs Greater Los Angeles Healthcare System
Authors: Yang Hong-Ho , Wu Tara J , Yu Alice C , Wells Christine , Orshansky Greg , Lee Jivianne T 
Published: February 2022

ABSTRACT

Introduction
While risk factors for severe COVID-19 infections have been well explored among the public, population-specific studies for the U.S. Veteran community are limited in the literature. By performing a comprehensive analysis of the demographics, comorbidities, and symptomatology of a population of COVID-19 positive Veterans Affairs (VA) patients, we aim to uncover predictors of death, survival, need for intubation, and need for nasal cannula oxygen support among this understudied community.

Materials and Methods
A retrospective review was conducted of 124 COVID-19 Veteran patients who were admitted from March to October 2020 to the VA Greater Los Angeles Healthcare System (IRB#2020-000272). Chi-square and Fisher’s exact tests were employed to assess differences in baseline demographic and clinical variables between Veterans who survived COVID-19 versus those who succumbed to COVID-19 illness. Multivariate logistic regression and Cox regression analyses were employed to assess predictors of outcome variables, including death, survival, need for intubation, and need for oxygen support (via nasal cannula). Covariates included a wide range of demographic, comorbidity-related, symptom-related, and summary index variables.

Results
Our study population consisted of primarily senior (average age was 73) Caucasian and African American (52.5% and 40.7%, respectively) Veterans. Bivariate analyses indicated that need for intubation was significantly associated with mortality (P = 0.002). Multivariate analyses revealed that age (P &lt; 0.001, adjusted odds ratio (OR) = 1.16), dyspnea (P = 0.015, OR = 7.73), anorexia (P = 0.022, OR = 16.55), initial disease severity as classified by WHO (P = 0.031, OR = 4.55), and having more than one of the three most common comorbidities (hypertension, diabetes, and cardiac disease) and symptoms (cough, fever, and dyspnea) among our sample (P = 0.009; OR = 19.07) were independent predictors of death. Furthermore, age (P &lt; 0.001, hazard ratio (HR) = 1.14), cerebrovascular disease (P = 0.022, HR = 3.76), dyspnea (P &lt; 0.001, HR = 7.71), anorexia (P &lt; 0.001, HR = 16.75), and initial disease severity as classified by WHO (P = 0.025, HR = 3.30) were independent predictors of poor survival. Finally, dyspnea reliably predicted need for intubation (P = 0.019; OR = 29.65).

Conclusions
Several independent predictors of death, survival, and need for intubation were identified. These risk factors may provide guidelines for risk-stratifying Veterans upon admission to VA hospitals. Additional investigations of COVID-19 prognosis should be conducted on the larger U.S. Veteran population to confirm our findings and add to the current body of literature.
Optimal timing of radiotherapy following brain metastases surgery
Authors: Yaghi Nasser K , Radu Stephanie , Nugent Joseph G , Mazur-Hart David J , Pang Brandi W , Bowden Stephen G , Murphy Blair , Han Seunggu J 
Published: February 2022

Abstract

Background
There is growing evidence supporting the need for a short time delay before starting radiotherapy (RT) treatment postsurgery for most optimal responses. The timing of RT initiation and effects on outcomes have been evaluated in a variety of malignancies, but the relationship remains to be well established for brain metastasis.

Methods
Retrospective study of 176 patients (aged 18–89 years) with brain metastases at a single institution (March 2009 to August 2018) who received RT following surgical resection. Time interval (≤22 and &gt;22 days) from surgical resection to initiation of RT and any potential impact on patient outcomes were assessed.

Results
Patients who underwent RT &gt;22 days after surgical resection had a decreased risk for all-cause mortality of 47.2% (95% CI: 8.60, 69.5%). Additionally, waiting &gt;40 days for RT after surgical resection more than doubled the risk of tumor progression; adjusted hazard ratio 2.02 (95% CI: 1.12, 3.64).

Conclusions
Findings indicate that a short interval delay (&gt;22 days) following surgical resection is required before RT initiation for optimal treatment effects in brain metastasis. Our timing of RT postsurgical resection data adds definition to current heterogeneity in RT timing, which is especially important for standardized clinical trial design and patient outcomes.
How can South Africa advance a new energy paradigm? A mission-oriented approach to megaprojects
Authors: Andreoni Antonio , Creamer Kenneth , Mazzucato Mariana , Steyn Grové 
Published: February 2022

Abstract
Green transition is a ‘wicked’ problem in that it is complex, systemic, interconnected, and urgent. In this paper we advance a ‘mission-oriented’ approach to reconceptualize energy megaprojects within a systemic, cross-sectoral, and challenge-driven policy framework for energy transition. This approach is operationalized through a discussion of project-level policy instruments including directional public finance, public procurement, and several types of conditionality. These instruments are geared towards shaping markets and industrial supply chains for green transition, and managing risks and rewards associated with energy megaprojects. We also look at the opportunities offered by a more decentralized energy system and the importance of building up state capacity and green coalitions supporting energy transition. We discuss this mission-oriented approach through a deep dive on the South African experience of energy megaprojects with a focus on the restructuring of its public utility, Eskom, as well as opportunities for sustainable industrialization.
Examining the Effects of a Universal Cash Transfer on Fertility
Authors: Cowan Sarah K , Douds Kiara Wyndham 
Published: February 2022

Abstract
Childbearing is at once deeply personal and shaped by social structure. It is also a site of profound inequality in the United States. Income inequality is an upstream cause of childbearing inequality, yet the evidence of the effect of income on reproduction is inconclusive. Previously, scholars primarily examined the introduction of means-tested relief to families with children. This limits analysis to families in poverty and provides insight only into the presence or absence of a policy. We analyze the Alaska Permanent Fund Dividend, which has provided all Alaskan residents with a substantial annual cash payment since 1982. The amount of the payment varies annually and is exogenous to individual Alaskans’ behavior and the state’s economy. We examine the effect of the cash transfers on fertility and abortion among a large and diverse population that has received varying amounts of money over time. We find the payments increase short-term fertility rates 1 and 2 years after disbursement, particularly among socioeconomically disadvantaged populations. Standardized to the 2010 household size distribution, two average payments relative to two minimum payments would result in a predicted fertility rate increase from 80.03 to 86.53 per 1,000 women age 15–44. The effect is largest for first births. The payments have no effect on the abortion rate. These results indicate the additional income removes economic constraints to reproductive health and autonomy and reduces reproductive inequality.