Exercise Therapy in the Management of Peripheral Arterial Disease.

The incidence and prevalence of peripheral artery disease (PAD) are increasing globally and have a marked economic burden in the United States. The American Heart Association/American College of Cardiology guidelines recommend exercise therapy as a Class 1A, but its utilization remains suboptimal. This state-of-the-art review aims to provide a comprehensive review of the most updated information available on PAD, along with its risk factors, management options, outcomes, economic burden, and the role of exercise therapy in managing PAD.

Cerebral Amyloid Angiopathy and Atrial Fibrillation: An up to Date Case Report.

Concurrent Cerebral Amyloid Angiopathy (CAA) and Atrial Fibrillation are becoming an increasingly common dilemma in clinical practice due to the aging population and the comorbidities associated with it. In such patients, the physician must appreciate and strike the difficult balance between the risk of ischemic strokes from atrial fibrillation on one hand, and that of intracerebral hemorrhage from coexisting CAA on the other. Anticoagulation is necessary for the former but potentially deleterious for the latter. In this case report, we present the case of a 67-year-old woman with a long history of atrial fibrillation on rivaroxaban who recently began to experience recurrent transient neurological deficits that were later diagnosed as amyloid spells related to concomitant CAA. While there is no clear-cut consensus in published literature on how to best manage these patients regarding the use of anticoagulation, it is recommended to involve a multidisciplinary team for optimal management of these patients.

Incidental Gastrointestinal Stromal Tumors (GIST) During Laparoscopic Sleeve Gastrectomy Procedures: a Retrospective Study.

PURPOSE: Gastrointestinal stromal tumors (GIST) are the most frequently occurring form of mesenchymal tumors in the gastrointestinal tract. Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric operation in which a portion of the gastric body and fundus is removed and sent for pathological examination. Increasingly, bariatric surgeons have incidentally identified neoplasms in the excised portion of the stomach. The aim of this study is to explore the incidence of GIST in obese patients undergoing LSG. MATERIAL AND METHODS: This is a single-center, single-surgeon retrospective case series which included 305 obese patients who underwent LSG. All excised stomach specimens were sent for pathologic analysis.. In the case of pathologically verified GIST (n = 6; 1.97%), detailed analysis was performed. RESULTS: In 305 LSG procedures, six cases of GIST (1.97%) were identified. The tumors were measured between 1 and 7 mm and were all low grade with negative resection margins. The mean BMI was 46.38 ± 3.94 kg/m2 (range: 41.61-51.77). The mean age at time of surgery was 55.33 ± 12.9 years (range: 37-73 years). All cases were asymptomatic and showed no evidence of metastatic disease. CONCLUSION: The incidental rate of GIST in the excised portion of the stomach in our 305 obese patients who underwent LSG is 6/305 (1.97%). This adds relevant data to the overall goal of determining whether obesity is a risk factor for GIST. Radical surgical resection of these tumors with adequate disease-free margins performed on a low-grade malignancy serves as a definitive oncological treatment, especially when there is an intact pseudocapsule.

Right Ventricular Outflow Tract Tachycardia As A Mode Of Presentation In A Covid-19 Patient.

The novel Coronavirus (SARS-CoV2) causes a multi system illness. Cardiac complications including a variety of arrhythmias have been reported. We report a young female with Right Ventricular Outflow Tract - Ventricular Tachycardia (RVOT-VT) as a first presenting symptom of Covid illness.

Cardiac Screening to Mitigate the Risk of Sudden Cardiac Death in Middle Eastern and African Competitive Athletes. A Systematic Review.

OBJECTIVE: The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009-2019 and aims to assess cardiac pre-participation screening methods. METHODS: A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. RESULTS: our studies fell within the inclusion criteria and were included in the study. Results identified a shortage in the literature regarding prevalence rates of SCD in the Middle East and Africa. Additionally, there seems to be a lack of ethnicity-specific cardiac pre-participation screening programs in the region. Nevertheless, the prevalence of SCD-related abnormalities (HCM, ARVC, etc …) ranged from 0.47 to 4.29%. Included studies conveyed only male athletes with no reports on the female athletic population. CONCLUSION: The present study highlights a need to develop an efficient cardiac pre-participation screening program specific to Arab and African athletes due to their high false-positive rates in contrast to Caucasian athletes. Significant evidence proves that an adequate cardiac screening program can prevent SCD in young competitive athletes. Therefore, it is imperative that future studies highlight the prevalence of abnormalities directly related to SCD in order to create a valid screening program that can be implemented in the region to mitigate the risk of shocking events.