Free Light Chains κ and λ as New Biomarkers of Selected Diseases.

Diagnostic and prognostic markers are necessary to help in patient diagnosis and the prediction of future clinical events or disease progression. As promising biomarkers of selected diseases, the free light chains (FLCs) κ and λ were considered. Measurements of FLCs are currently used in routine diagnostics of, for example, multiple myeloma, and the usefulness of FLCs as biomarkers of monoclonal gammopathies is well understood. Therefore, this review focuses on the studies concerning FLCs as new potential biomarkers of other disorders in which an inflammatory background has been observed. We performed a bibliometric review of studies indexed in MEDLINE to assess the clinical significance of FLCs. Altered levels of FLCs were observed both in diseases strongly connected with inflammation such as viral infections, tick-borne diseases or rheumatic disorders, and disorders that are moderately associated with immune system reactions, e.g., multiple sclerosis, diabetes, cardiovascular disorders and cancers. Increased concentrations of FLCs appear to be a useful prognostic marker in patients with multiple sclerosis or tick-borne encephalitis. Intensive synthesis of FLCs may also reflect the production of specific antibodies against pathogens such as SARS-CoV-2. Moreover, abnormal FLC concentrations might predict the development of diabetic kidney disease in patients with type 2 diabetes. Markedly elevated levels are also associated with increased risk of hospitalization and death in patients with cardiovascular disorders. Additionally, FLCs have been found to be increased in rheumatic diseases and have been related to disease activity. Furthermore, it has been suggested that inhibition of FLCs would reduce the progression of tumorigenesis in breast cancer or colitis-associated colon carcinogenesis. In conclusion, abnormal levels of κ and λ FLCs, as well as the ratio of κ:λ, are usually the result of disturbances in the synthesis of immunoglobulins as an effect of overactive inflammatory reactions. Therefore, it seems that κ and λ FLCs may be significant diagnostic and prognostic biomarkers of selected diseases. Moreover, the inhibition of FLCs appears to be a promising therapeutical target for the treatment of various disorders where inflammation plays an important role in the development or progression of the disease.

Perceived barriers to effective use of telehealth in managing the care of patients with cardiovascular diseases: a qualitative study exploring healthcare professionals' views in Jordan.

BACKGROUND: The use of telehealth in the management of care and care delivery has been increasing significantly during the COVID-19 pandemic. Telehealth is an emerging technology used to manage care for patients with cardiovascular diseases (CVDs) in Jordan. However, implementing this approach in Jordan faces many challenges that need to be explored to identify practical solutions. PURPOSE: To explore the perceived challenges and barriers to using telehealth in managing acute and chronic CVDs among healthcare professionals. METHODS: A qualitative, exploratory study was conducted by interviewing 24 health professionals at two hospitals in different clinical areas in Jordan. RESULTS: Several barriers were reported by participants that affected the utilization of telehealth services. The barriers were categorized into the following four themes: Drawbacks related to patients, Health providers' concerns, Procedural faults, and telehealth To complement the service only. CONCLUSIONS: The study suggests that telehealth can be instrumental in supporting care management for patients with CVD. It means that understanding the advantages and barriers to implementing telehealth by the healthcare providers in Jordan can improve many aspects of the healthcare services for patients with CVD within the healthcare settings in Jordan.

Intraoperative ventricular septal rupture: A case report.

Ventricular septal rupture (VSR) is a rare complication of myocardial infarction that requires surgical repair. Herein, we describe a case of intraoperative VSR requiring patch repair and postoperative extracorporeal membrane oxygenation (ECMO) support. This case highlights the risk factors, patient presentation, and management recommendations for this potentially lethal pathology.

Upper extremity deep venous thrombosis after BNT162b2 mRNA COVID-19 vaccine case report.

We describe a case of an otherwise healthy 60-year-old female patient who presented 6 days after receipt of the second dose of the BNT162b2 mRNA COVID-19 (Pfizer/BioNTech) vaccine and was found to have upper extremity deep venous thrombosis.

Association between cardiovascular risk and coronavirus disease 2019: findings from 2021 National Health Interview Survey.

PURPOSE: To examine the association between pre-existing cardiovascular disorders and the risk of coronavirus disease 2019 (COVID-19) among community-dwelling adults in the United States. METHODS: We analyzed data from the 2021 National Health Interview Survey, encompassing 28,848 nationally representative participants aged ≥18. We examined the association by two age groups, younger adults (aged 18-59) and older adults (aged ≥60). Weighted analyses were conducted to consider the complex sampling design used in the National Health Interview Survey. RESULTS: The results show that 13.9% of younger and 8.2% of older adults were infected with coronavirus, corresponding to a nationwide estimate of 23,701,358 COVID-19 cases in younger adults and 6310,206 in older adults in 2021. Pre-existing cardiovascular risk factors (overweight, obesity, hypertension, and diabetes) in both age groups and pre-existing cardiovascular diseases (angina, heart attack, and coronary heart disease) in older adults were significantly associated with COVID-19 infection. Significant dose-response relationships existed between increased pre-existing cardiovascular risk factors and COVID-19 infection, with the strongest association in non-Hispanic Black, followed by Hispanic ethnicities and non-Hispanic White. CONCLUSIONS: Pre-existing cardiovascular disorders are significantly associated with the risk of COVID-19 infection. The magnitudes of this risk association are more substantial among minority populations.

Cardiac complications in COVID-19 infected patients admitted in a tertiary care hospital in Karachi

The objective of the current cross-sectional study was to determine the frequency, types, associations, and outcome of cardiac complications in hospitalized COVID-19 infected patients. This study was conducted at Dr. Ziauddin University Hospital, Clifton campus, Karachi, from 1st April 2020 to 31st March 2021. A total number of 1,050 patients were included in the study through consecutive sampling with the diagnosis of COVID-19 infection. Patients were labeled as having complications secondary to COVID pneumonia only after comparing their hospital's clinical course with their baseline status. The independent variables were age, gender, cardiovascular risk factors (smoking status, diabetes mellitus, and hypertension), while the dependent variables were cardiac complications including acute coronary syndrome, myocarditis, pericarditis, and arrhythmias. The Association of complications with independent variables was analyzed by applying the Chi-Square test and statistical significance was set at a P-value of 0.05. There were 599 (57.0%) males and 451 (43.0%) females with the mean age of the participants being 55.1 years (+or- 13.08) years. Diabetes and hypertension were present in 451 (43.0%) and 490 (46.6%) patients respectively. Out of 1050 patients, the primary endpoint occurred in 55.6% of patients, including 23.1% acute coronary syndrome, 19.3% arrhythmias, 10.8% myocarditis, and 2.2% pericarditis. Analysis of secondary endpoint showed that 31.1% of patients had severe disease out of which the mortality was 39.4%. Acute coronary syndrome and atrial fibrillation are frequent complications, especially in those with severe disease and multi-organ dysfunction. Furthermore, the incidence of these complications is higher in patients with multiple co-morbidities. Considering the devastating impact this pandemic has had globally, it is important to know the cardiac involvement this condition can have along with the debilitating outcome so that healthcare facilities can be upgraded to provide better care to save lives.

Cardiovascular patients in COVID-19 era, a case series, an experience from a tertiary cardiovascular center in Tehran, Iran.

Different cardiovascular presentations of coronavirus disease 2019 can be seen because of the systemic involvement. Considering its new presentations, there is need for further studies regarding the mechanistic pathways involved.

A cost effectiveness analysis of the nutritious eating with soul study

PURPOSE Historically, African Americans (AA) have been underrepresented in nutrition-related behavioral research despite their disproportionate higher risk of cardiovascular disease (CVD). The Nutritious Eating with Soul (NEW Soul) Study is one of the first of its kind to recruit an AA only study group to examine CVD prevention via a clinical trial to examine changes in CVD risk factors across two cohorts who are randomly assigned to a plant-based, soul food vegan diet or low-fat omnivorous (omni) diet. The purpose of cost effectiveness analysis (CEA) is to inform clinical and policy decisions and the costs of interventions that society is willing to pay for. However, few studies have examined the cost effectiveness of behavioral interventions for AA adults. The purpose of this study was to evaluate the cost effectiveness of the nutrition and behavior change interventions of the NEW Soul Study, from a societal perspective, by examining direct costs to deliver the intervention, and indirect costs reported by participants associated with intervention adherence. METHODS Primary data were collected from AA adults (n=105) between the ages of 18-65 from the Midlands SC region, who enrolled in the NEW Soul Study, across two cohorts, and were identified as having overweight or obesity (BMI 25-49.9 kg/m2). Upon completion of baseline assessment of weight, and other laboratory measures, participants were randomized to follow a vegan or low-fat omni diet. A cost effectiveness analysis (CEA) of this randomized control trial is based on one-year outcomes collected in April 2019 for Cohort 1 and June-July 2020 for Cohort 2. An incremental cost effectiveness ratio (ICER) over the one-year study period was calculated based on the intervention (direct) and societal (indirect) costs and weight loss. Total Costs = Costs to deliver the intervention (ingredients for cooking demonstrations, meals) + participants' average cost of weekly groceries + average weekly costs of dining out. Quality adjusted life year (QALY) was calculated based on Short Form-12 survey responses that were collected at baseline and one year. Variations in weight loss between cohorts 1 and 2 before COVID-19 and during COVID-19 were assessed using a difference-in-difference (DD) study design. RESULTS The incremental cost effectiveness ratio (ICER) was $2,888.57 per pound of weight loss. The results fall within quadrant II of the cost effectiveness plane which indicates that the vegan diet group, as compared to the omni diet group was more cost effective, as participants in that diet group experienced greater weight loss in addition to the intervention costing less. Results from the least squares means estimate from DD models (adjusted for covariates) reveal that both diet groups experienced some gains in QALY from baseline to 12 months (omni baseline = 0.7889;omni 12 months= 0.804;vegan baseline =0.8027;vegan 12 months = 0.808), however there was no statistically significant DD in QALY between diet groups (Pr > t = 0.6485). Pre-COVID, Cohort 1 participants lost an average of 10.2 pounds at 12 months from baseline. During COVID, Cohort 2 participants lost an average of 3.7 pounds at 12 months from baseline. The difference-in-differences in weight loss pre-COVID and during COVID by diet group revealed a statistically significant change in weight loss at 12 months compared to baseline between cohorts 1 and 2 for the vegan diet group (p=0.0408). Pre-COVID (C1), the vegan diet group lost an average of 11 pounds. During COVID (C2), the vegan diet group lost an average of 3.47 pounds.CONCLUSIONS The vegan diet intervention produced clinically relevant weight loss at a lower cost and was therefore cost-effective. Both diet groups experienced similarly minimal gains in QALYs and the DD in QALYs between the vegan and omni groups was not statistically significant. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Artificial Intelligence-Based Phonocardiogram: Classification Using Cepstral Features

When cardiovascular issues arise in a cardiac patient, it is essential to diagnose them as soon as possible for monitoring and treatment would be less difficult than in the old. Paediatric cardiologists have a difficult time keeping track of their patients’ cardiovascular condition. To accomplish this, a phonocardiogram (PCG) device was created in combination with a MATLAB software based on artificial intelligence (AI) for automatic diagnosis of heart state classification as normal or pathological. Due to the safety concerns associated with COVID-19, testing on school-aged children is currently being explored. Using PCG analyses and machine learning methods, the goal of this work is to detect a cardiac condition, whilst operating on a limited amount of computing resources. This makes it possible for anybody, including non-medical professionals, to diagnose cardiac issues. To put it simply, the current system consists of a distinct portable electronic stethoscope, headphones linked to the stethoscope, a sound-processing computer, and specifically developed software for capturing and analysing heart sounds. However, this is more difficult and time-consuming, and the accuracy is lowered as a result. According to statistical studies, even expert cardiologists only achieve an accuracy of approximately 80%. Nevertheless, primary care doctors and medical students usually attain a level of accuracy of between 20 and 40%. Due to the nonstationary nature of heart sounds and PCG's superior ability to model and analyse even in the face of noise, PCG sounds provide valuable information regarding heart diseases. Spectral characteristics PCG is used to characterise heart sounds in order to diagnose cardiac conditions. We categorise normal and abnormal sounds using cepstral coefficients, or PCG waves, for fast and effective identification, prompted by cepstral features’ effectiveness in speech signal classification. On the basis of their statistical properties, we suggest a new feature set for cepstral coefficients. The PhysioNet PCG training dataset is used in the experiments. This section compares KNN with SVM classifiers, indicating that KNN is more accurate. Furthermore, the results indicate that statistical features derived from PCG Mel-frequency cepstral coefficients outperform both frequently used wavelet-based features and conventional cepstral coefficients, including MFCCs. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Fatal association of COVID-19 and acute type A aortic dissection.

Type A aortic dissection is a catastrophic event that requires prompt diagnosis and intervention to save the patient. It seems that type A aortic dissection in COVID-19 patients has increased severity, and even with immediate diagnosis, it has a high mortality.

Cardiovascular disturbances in COVID-19: an updated review of the pathophysiology and clinical evidence of cardiovascular damage induced by SARS-CoV-2.

Severe acute respiratory coronavirus-2 (SARS-Co-2) is the causative agent of coronavirus disease-2019 (COVID-19). COVID-19 is a disease with highly variable phenotypes, being asymptomatic in most patients. In symptomatic patients, disease manifestation is variable, ranging from mild disease to severe and critical illness requiring treatment in the intensive care unit. The presence of underlying cardiovascular morbidities was identified early in the evolution of the disease to be a critical determinant of the severe disease phenotype. SARS-CoV-2, though a primarily respiratory virus, also causes severe damage to the cardiovascular system, contributing significantly to morbidity and mortality seen in COVID-19. Evidence on the impact of cardiovascular disorders in disease manifestation and outcome of treatment is rapidly emerging. The cardiovascular system expresses the angiotensin-converting enzyme-2, the receptor used by SARS-CoV-2 for binding, making it vulnerable to infection by the virus. Systemic perturbations including the so-called cytokine storm also impact on the normal functioning of the cardiovascular system. Imaging plays a prominent role not only in the detection of cardiovascular damage induced by SARS-CoV-2 infection but in the follow-up of patients' clinical progress while on treatment and in identifying long-term sequelae of the disease.

Multiple Aspects of Inappropriate Action of Renin-Angiotensin, Vasopressin, and Oxytocin Systems in Neuropsychiatric and Neurodegenerative Diseases.

The cardiovascular system and the central nervous system (CNS) closely cooperate in the regulation of primary vital functions. The autonomic nervous system and several compounds known as cardiovascular factors, especially those targeting the renin-angiotensin system (RAS), the vasopressin system (VPS), and the oxytocin system (OTS), are also efficient modulators of several other processes in the CNS. The components of the RAS, VPS, and OTS, regulating pain, emotions, learning, memory, and other cognitive processes, are present in the neurons, glial cells, and blood vessels of the CNS. Increasing evidence shows that the combined function of the RAS, VPS, and OTS is altered in neuropsychiatric/neurodegenerative diseases, and in particular in patients with depression, Alzheimer's disease, Parkinson's disease, autism, and schizophrenia. The altered function of the RAS may also contribute to CNS disorders in COVID-19. In this review, we present evidence that there are multiple causes for altered combined function of the RAS, VPS, and OTS in psychiatric and neurodegenerative disorders, such as genetic predispositions and the engagement of the RAS, VAS, and OTS in the processes underlying emotions, memory, and cognition. The neuroactive pharmaceuticals interfering with the synthesis or the action of angiotensins, vasopressin, and oxytocin can improve or worsen the effectiveness of treatment for neuropsychiatric/neurodegenerative diseases. Better knowledge of the multiple actions of the RAS, VPS, and OTS may facilitate programming the most efficient treatment for patients suffering from the comorbidity of neuropsychiatric/neurodegenerative and cardiovascular diseases.

Genophenotypic Factors and Pharmacogenomics in Adverse Drug Reactions.

Adverse drug reactions (ADRs) rank as one of the top 10 leading causes of death and illness in developed countries. ADRs show differential features depending upon genotype, age, sex, race, pathology, drug category, route of administration, and drug-drug interactions. Pharmacogenomics (PGx) provides the physician effective clues for optimizing drug efficacy and safety in major problems of health such as cardiovascular disease and associated disorders, cancer and brain disorders. Important aspects to be considered are also the impact of immunopharmacogenomics in cutaneous ADRs as well as the influence of genomic factors associated with COVID-19 and vaccination strategies. Major limitations for the routine use of PGx procedures for ADRs prevention are the lack of education and training in physicians and pharmacists, poor characterization of drug-related PGx, unspecific biomarkers of drug efficacy and toxicity, cost-effectiveness, administrative problems in health organizations, and insufficient regulation for the generalized use of PGx in the clinical setting. The implementation of PGx requires: (i) education of physicians and all other parties involved in the use and benefits of PGx; (ii) prospective studies to demonstrate the benefits of PGx genotyping; (iii) standardization of PGx procedures and development of clinical guidelines; (iv) NGS and microarrays to cover genes with high PGx potential; and (v) new regulations for PGx-related drug development and PGx drug labelling.

Molecularly imprinted spongy columns for Angiotensin(II) recognition from human serum.

Angiotensin II (AngII), the effector peptide of the renin angiotensin system and has an important role in regulating cardiovascular hemodynamics and structure. AngII is an important biomarker for certain diseases that are associated with cardiovascular disorders, i.e., influenza, SARS-CoV-2, tumors, hypertension, etc. However, AngII presents in blood in very low concentrations and they are not stable due to their reactivity, therefore spontaneous detection of AngII is a big challenge. In this study, AngII-imprinted spongy columns (AngII-misc) synthesized for AngII detection from human serum, and characterized by surface area measurements (BET), swelling tests, scanning electron microscopy (SEM), FTIR studies. AngII binding studies were achieved from aqueous environment and maximum binding capacity was found as 0.667 mg/g. It was calculated that the AngII-miscs recognized AngII 8.27 and 14.25 times more selectively than competitor Angiotensin I and Vasopressin molecules. Newly produced AngII-misc binds 60.5 pg/g AngII from crude human serum selectively. It has a great potential for spontaneous detection of AngII from human serum for direct and critical measurements in serious diseases, that is, heart attacks, SARS-CoV-2, etc.

COVID-19 and cardiovascular system-a comprehensive review.

Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.

Cardiac Rehabilitation: A Bibliometric Review From 2001 to 2020.

Cardiovascular disease (CVD) is a serious threat to global public health due to its high prevalence and disability rate. Meanwhile, cardiac rehabilitation (CR) has attracted increasing attention for its positive effects on the cardiovascular system. There is overwhelming evidence that CR for patients with CVD is effective in reducing cardiovascular morbidity and mortality. To learn more about the development of CR, 5,567 papers about CR and related research were retrieved in the Web of Science Core Collection from 2001 to 2020. Then, these publications were scientometrically analyzed based on CiteSpace in terms of spatiotemporal distribution, author distribution, subject categories, topic distribution, and references. The results can be elaborated from three aspects. Firstly, the number of annual publications related to CR has increased year by year in general over the past two decades. Secondly, a co-occurrence analysis of the output countries and authors shows that a few developed countries such as the United States, Canada, and the UK are the most active in carrying out CR and where regional academic communities represented by Sherry Grace and Ross Arena were formed. Thirdly, an analysis of the subject categories and topic distribution of the papers reveals that CR is a typical interdiscipline with a wide range of disciplines involved, including clinical medicine, basic medicine, public health management, and sports science. The research topics cover the participants and implementers, components, and the objectives and requirements of CR. The current research hotspots are the three core modalities of CR, namely patient education, exercise training and mental support, as well as mobile health (mHealth) dependent on computer science. In conclusion, this work has provided some useful information for acquiring knowledge about CR, including identifying potential collaborators for researchers interested in CR, and discovering research trends and hot topics in CR, which can offer some guidance for more extensive and in-depth CR-related studies in the future.

Reduction of Emergency Calls and Hospitalizations for Cardiac Causes: Effects of Covid-19 Pandemic and Lockdown in Tuscany Region.

Introduction: Containment measures were established to flatten the curve of COVID-19 contagion in order to avoid a crash of the healthcare system. However, these measures influenced the rate of hospitalization of cardiac patients. In this study, we aimed to analyse the impact of COVID-19 and the effects of lockdown measures on hospital admissions and alerts of emergency medical system (EMS) for cardiac causes in the Tuscany region. Methods: An observational, retrospective analysis from Italian Tuscany region was conducted. We evaluated consecutive patients contacting EMS or admitted to the 39 Emergency Departments (EDs) in Tuscany for cardiac causes in the first trimester of 2020. Data were compared with the same period in 2018/19. Results: The alerts of EMS for cardiac causes significantly decrease in 2020 and the highest difference between 2018/19 and 2020 was found immediately after national lockdown (Δ = -47.4%, p < 0.001). The number of admissions for chest pain in the EDs also decreased, with a maximum difference of -67.6% (p < 0.001) vs. 2018/19. The number of hospital accesses for acute coronary syndromes, atrial fibrillation, and heart failure in the EDs significantly decreased in 2020 as compared to 2018/19 (maximum Δ = -58.9%, p < 0.001; maximum Δ = -63.0%, p < 0.001; maximum Δ = -72.7%, p < 0.001, respectively). Conclusions: A significant decrease in the contacts to EMS for cardiac causes and in cardiac diagnoses was observed during the first trimester of 2020. Fear of contagion has likely played a relevant role. The lesson learnt from first wave of COVID-19 pandemic suggests that appropriate public information strategies and re-education of people are essential.

Cardiac magnetic resonance findings in coronavirus disease 2019.

A subgroup of COVID-19 patients with cardiac magnetic resonance imaging evidence of myocardial inflammation may exhibit subendocardial fibrosis, compatible with myocardial infarction, while epicardial coronary arteries are normal.

Exercise, Immune System, Nutrition, Respiratory and Cardiovascular Diseases during COVID-19: A Complex Combination.

Coronaviruses (CoVs) represent a large family of RNA viruses that can infect different living species, posing a global threat to human health. CoVs can evade the immune response, replicate within the host, and cause a rapid immune compromise culminating in severe acute respiratory syndrome. In humans, the immune system functions are influenced by physical activity, nutrition, and the absence of respiratory or cardiovascular diseases. This review provides an in-depth study between the interactions of the immune system and coronaviruses in the host to defend against CoVs disease.