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Objectives: To determine the usefulness of cardiovascular physical examination (CPE) as a screening tool in a lowresource setting for detecting congenital heart disease (CHD) in newborns delivered at the Maternity Unit of Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Design: A hospital-based cross-sectional study with a comparison group component. Setting: Maternity Unit of the KBTH, Accra, Ghana. Participants: Over eight months, newborns aged 1-14 days delivered at ≥ 34 weeks' gestation at the Maternity Unit, KBTH, were recruited into the study. Intervention: Each newborn was examined using a set of CPE parameters for the presence of congenital heart disease. Those with suggestive features of CHD had a confirmatory echocardiogram test. Main Outcome Measure: Abnormal CPE features and their corresponding echocardiogram findings. Results: A total of 1607 were screened, with 52 newborns showing signs of CHD on CPE, of which 20 newborns were proven on echocardiogram to have congenital heart disease. Abnormal CPE parameter that was associated with CHD was murmur (P=0.001), dysmorphism (p=0.01), newborns with chest recessions (p=0.01) and lethargy (p=0.02). CPE's sensitivity, specificity, and positive and negative predictive values were 95%, 60.7%, 36.5% and 98,1%, respectively. The most common acyanotic CHD found was isolated atrial septal defect (ASD), followed by patent ductus arteriosus (PDA). The only cyanotic CHD found was a case of tricuspid atresia. Conclusion: Cardiovascular physical examination at birth is an effective and inexpensive screening tool for detecting CHD in newborns, which can easily be utilised in low-resource settings.
Subject(s)
Physical Examination , Mass Screening , Diagnosis , Heart Defects, Congenital , Infant, Newborn , Cardiovascular Diseases , Hospitals, TeachingABSTRACT
Introducción. La enfermedad cardiovascular constituye la primera causa de morbimortalidad a nivel mundial. La rehabilitación cardiovascular basada en ejercicio surge como herramienta eficaz para controlar factores de riesgo cardiovascular y mejorar determinantes de salud como el fitness cardiorrespiratorio, sin embargo, no existen revisiones actualizadas que indiquen el efecto de la fase de mantención de rehabilitación cardiovascular sobre esta variable. Objetivo. Determinar el efecto de la rehabilitación cardiovascular basada en ejercicio en fase de mantención sobre el fitness cardiorrespiratorio en adultos con enfermedad cardiovascular. Método. Se realizó la búsqueda de estudios a través de PubMed, Google Scholar y Web of Science desde el año 2010 hasta agosto de 2021. Se seleccionaron estudios que incluyeran individuos adultos de ambos sexos y cualquier raza con enfermedad cardiovascular, que analicen el efecto de la rehabilitación cardiovascular basada en ejercicio en fase de mantención sobre el fitness cardiorrespiratorio. La calidad metodológica se evaluó a través de la escala PEDro a través de dos revisores. Se analizaron de manera cualitativa variables secundarias como calidad de vida, antropometría y perfil lipídico y nivel de actividad física. Resultados. La búsqueda arrojó 541 resultados, de los cuales se seleccionaron 8 estudios. La edad promedio de los individuos fue 60,7±9,5 años, la mayoría de los ensayos incluyen individuos con cardiopatía coronaria. Los resultados muestran la mantención o mejora del fitness cardiorrespiratorio y la mantención de calidad de vida, antropometría y perfil lipídico y nivel de actividad física. La calidad de los estudios con escala PEDro fue en 6,18/10 en promedio de dos evaluadores. Conclusión. La rehabilitación cardiovascular basada en ejercicio en fase de mantención logra mantener o mejorar el fitness cardiorrespiratorio en adultos con enfermedad cardiovascular.
Background. Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Exercise-based cardiovascular rehabilitation emerges as an effective tool to control cardiovascular risk factors and improve health determinants such as cardiorespiratory fitness, however, there are no updated reviews that indicate the effect of the maintenance phase of cardiovascular rehabilitation on this variable. Objective. To determine the effect of exercise-based cardiovascular rehabilitation in the maintenance phase on cardiorespiratory fitness in adults with cardiovascular disease. Method. The search for studies was carried out through PubMed, Google Scholar and Web of Science from 2010 to August 2021. Studies selected included adult individuals of both sexes and any race with cardiovascular disease, which analyzed the effect of cardiovascular rehabilitation based on maintenance phase exercise on cardiorespiratory fitness. The methodological quality was evaluated through the PEDro scale through two reviewers. Secondary variables such as quality of life, anthropometry and lipid profile, and level of physical activity were analyzed qualitatively. Results. The search yielded 541 results, of which 8 studies were selected. The average age of the individuals was 60.7±9.5 years, most trials include individuals with coronary heart disease. The results show the maintenance or improvement of cardiorespiratory fitness and the maintenance of quality of life, anthropometry and lipid profile and level of physical activity. The quality of the studies with the PEDro scale was 6.18/10 on average of two evaluators Conclusion. Cardiovascular rehabilitation based on exercise in the maintenance phase manages to maintain or improve cardiorespiratory fitness in adults with cardiovascular disease.
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Objective: to evaluate the correlation between a group of conventional biomarkers of cardiovascular risk with the Castelli-I and Castelli-II indices, and TG/HDL-C ratio in patients assigned to a program of cardiovascular risk for users of the clinical laboratory service of an institution that provides health services in the southwest of the Colombia.Materials and Methods: retrospective, descriptive multivariate exploratory study, carried out in 2 126 patients. Some sociodemographic variables were analyzed, as well as glucose and lipid profile. The Castelli-I and Castelli-II indices, and TG/HDL-C ratio were calculated. The correlation among the variables was evaluated through a matrix of correlations, the correlation index and the Bartlett's Test of Sphericity. The analysis ended with a study of main components, which allowed to identify how the variables studied were grouped into components that characterized the population. Results: the average age was 56 ± 11 years; 68.7% were women; 48% hypercholesterolemic and 49% hypertriglyceridemic; 22% with alterations in glucose. Total cholesterol correlated positively with LDL-C and triglycerides negatively with HDL-C. Two components characterized the population, one related to cardiovascular risk and the other to lipid alterations. Conclusions: conventional biomarkers reveal high prevalences in dyslipidemias, in contrast to atherogenic indices. The results highlight the importance of considering the evaluation of these indices in primary care and the need to strengthen the measurement systems of clinical laboratories for the reliability of the data on which decisions are made for the management of these patients..(AU)
Objetivo: evaluar la correlación entre un grupo de biomarcadores convencionales de riesgo cardiovascular con los índices de Castelli-I, Castelli-II y TG/cHDL en pacientes de riesgo cardiovascular usuarios del servicio de laboratorio clínico de una institución prestadora de servicios de salud del suroccidente de Colombia. Materiales y Métodos: estudio retrospectivo, descriptivo multivariado exploratorio, llevado a cabo en 2 126 pacientes. Se analizaron algunas variables sociodemográficas, glucosa y perfil lipídico. Se calcularon los índices de Castelli I/II y el índice de TG/cHDL. La correlación entre las variables se evaluó a través de una matriz de correlaciones, el índice de correlación y el Test de Esfericidad de Bartlet. El análisis finalizó con un estudio de componentes principales que permitió identificar como se agrupaban las variables estudiadas en componentes que caracterizaban a la población. Resultados: la edad promedio fue de 56±11 años, 68,7% fueron mujeres; 48% ipercolesterolemicos y 49% hipertrigliceridemicos; 22% con alteraciones en la glucosa. El colesterol total correlacionó positivamente con cLDL y los triglicéridos negativamente con cHDL. Dos componentes caracterizaron la población, uno relacionado con el riesgo cardiovascular y otro con las alteraciones lipídicas. Conclusiones: los biomarcadores convencionales develan altas prevalencias en las dislipidemias en contraste con los índices aterogénicos. Los resultados resaltan la importancia de considerar la evaluación de estos índices en atención primaria y la necesidad de fortalecer los sistemas de medición de los laboratorios clínicos para la confiabilidad de los datos sobre los cuales se toman decisiones en el manejo de estos pacientes.
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Humans , Biomarkers , Cardiovascular DiseasesABSTRACT
@#Introduction: Determination of learning needs is central for holistic patient education, to sustain behavior changes and to control patient’s risk factor. However, patients often sense that their learning needs are unmet and information provided was too general. Thus, this study aimed to determine the perceived learning needs and their level of importance among Coronary Artery Disease (CAD) patients. Methods: The current investigation is a descriptive, cross-sectional study for which all CAD patients were selected using the cencus method. The data was collected using Cardiac Patients Learning Needs Inventory. The questionnaire was delivered to 140 CAD patients who had their follow-up in a cardiology clinic. The instrument is reliable with a Cronbach’s alpha coefficient of 0.96. The study design followed STROBE cross-sectional design process guideline. Results: Participants’ mean age was 58.96 ± 9.42 years. More than half of the participants were males (62.9%), employed (52.0%) and had attained secondary level education (69.3%). Around two-thirds (60.7%) of the patients perceived to have high learning needs. Gender and highest educational achievement were significantly associated with perceived learning needs. The most significant perceived learning needs were medication information, risk factors for CAD, information on diet, physical activity, anatomy and physiology, and other related information. Conclusion: This study has identified the important domains of learning needs among CAD patients. Findings from the present study will provide important input for future cardiac educational strategies to reduce the rate of hospital readmission and death.
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Nonalcoholic fatty liver disease (NAFLD) is a multi-system disease, and metabolic syndrome, type 2 diabetes, and NAFLD interact as both cause and effect. Deaths caused by cardiovascular diseases and malignant tumors are the adverse outcome of patients with NAFLD and nonalcoholic steatohepatitis (NASH), and increased deaths caused by liver disease is mainly seen in NASH patients. There is a causal relationship between NASH and hepatocellular carcinoma, and almost 50% of patients with NASH-associated hepatocellular carcinoma do not have liver cirrhosis. At present, cohort studies on the natural history of NAFLD in China should be enhanced in order to provide a basis for the development of health strategies and prevention and treatment measures. This editorial elaborates on the association of NAFLD with diabetes, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma from the perspective of clinical epidemiology, in order to emphasize the importance of the natural history of NAFLD.
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@#The latest reports showed that kidney secrets a new type protein:renalase,a novel flavin adenine dinucleotide-dependent(FAD-dependent)amine oxidase which is secreted into the blood by the kidney and regulates heart function and blood pressure by metabolizing catecholamines.Kidney disease is associated with cardiovascular disease,so people pay more and more attentions to renalase.This article will introduce the structure and mechanism of renalase,and propose its future.
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@#There is increasing evidence that stress contributes to cardiovascular disease.Chronic stress can precipitate the atherosclerotic process through increased allostatic load,which is mediated by the neuroendocrine systems(sympathetic nervous system and hypothalamus-pituitary-adrenal axis),and through related chronic risk factors(insulin resistance,hypertension,diabetes and hyperlipidemia).On the other hand,acute stress can trigger cardiovascular events through sympathetic nervous activation and enhancement of acute risk factors(increased blood pressure,endothelial cell dysfunction,increased blood viscosity,and platelet and hemostatic activation).Earthquake represents a good example of naturally occurring acute and chronic stress.Thus,in order to develop applicable prevention strategies,it is important to investigate factors and potential mechanisms by which cardiovascular events are triggered following earthquake.In this review we refine some possible mechanisms by which earthquake impacts on cardiovascular system from previously published literatures,and suggest some possible approaches to preventing cardiovascular events associated with earthquake.
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@#There is increasing evidence that stress contributes to cardiovascular disease.Chronic stress can precipitate the atherosclerotic process through increased allostatic load,which is mediated by the neuroendocrine systems(sympathetic nervous system and hypothalamus-pituitary-adrenal axis),and through related chronic risk factors(insulin resistance,hypertension,diabetes and hyperlipidemia).On the other hand,acute stress can trigger cardiovascular events through sympathetic nervous activation and enhancement of acute risk factors(increased blood pressure,endothelial cell dysfunction,increased blood viscosity,and platelet and hemostatic activation).Earthquake represents a good example of naturally occurring acute and chronic stress.Thus,in order to develop applicable prevention strategies,it is important to investigate factors and potential mechanisms by which cardiovascular events are triggered following earthquake.In this review we refine some possible mechanisms by which earthquake impacts on cardiovascular system from previously published literatures,and suggest some possible approaches to preventing cardiovascular events associated with earthquake.