Knowledge, attitude, and practices of the community toward dengue fever in Shabwah Governorate, Yemen: a descriptive study.

BACKGROUND: In Yemen, dengue fever (DF) is a widespread, locally endemic infectious disease, with high morbidity and mortality which mainly affects impoverished regions. Thus, this study aims to evaluate the knowledge, attitudes, and behaviors of the Shabwah community in Yemen regarding DF characteristics and prevention. METHODS: The present study is a cross-sectional community-based study conducted in Shabwah Governorate, Yemen, between June 2021 and November 2021. Simple random sampling was used to select the sample (n = 370), and a validated closed-ended questionnaire was used to collect data. RESULTS: In total, 370 individuals participated in this study; most respondents were female (N = 247, 66.8%), and more than half (N = 214, 57.8%) were younger than age 30. More than 50% of the population had completed a primary or secondary school, while approximately 33.03% of them were illiterate. Furthermore, more than half (53.5%) of the population had good knowledge of DF, while most of those educated at a university level (64.1%) had good attitude toward DF. Most of the population (68.4%) had good practice toward DF. Moreover, participants with a university level education, followed by those who completed secondary school, had significantly higher knowledge and practice scores than primary school and illiteracy (P = 0.05). CONCLUSION: The results of the study indicate that the residents of Yemen's Shabwah Governorate are well-informed about the symptoms and signs of DF, have a positive attitude toward the disease, and employ appropriate preventive measures. Health education via various media should be mandated to increase community awareness and dispel misconceptions about DF.

Bariatric Surgery-Induced Cardiac and Lipidomic Changes in Obesity-Related Heart Failure with Preserved Ejection Fraction.

OBJECTIVE: To determine the effects of gastric bypass on myocardial lipid deposition and function and the plasma lipidome in women with obesity and heart failure with preserved ejection fraction (HFpEF). METHODS: A primary cohort (N = 12) with HFpEF and obesity underwent echocardiography and magnetic resonance spectroscopy both before and 3 months and 6 months after bariatric surgery. Plasma lipidomic analysis was performed before surgery and 3 months after surgery in the primary cohort and were confirmed in a validation cohort (N = 22). RESULTS: After surgery-induced weight loss, Minnesota Living with Heart Failure questionnaire scores, cardiac mass, and liver fat decreased (P < 0.02, P < 0.001, and P = 0.007, respectively); echo-derived e' increased (P = 0.03), but cardiac fat was unchanged. Although weight loss was associated with decreases in many plasma ceramide and sphingolipid species, plasma lipid and cardiac function changes did not correlate. CONCLUSIONS: Surgery-induced weight loss in women with HFpEF and obesity was associated with improved symptoms, reverse cardiac remodeling, and improved relaxation. Although weight loss was associated with plasma sphingolipidome changes, cardiac function improvement was not associated with lipidomic or myocardial triglyceride changes. The results of this study suggest that gastric bypass ameliorates obesity-related HFpEF and that cardiac fat deposition and lipidomic changes may not be critical to its pathogenesis.

Effects of phosphodiesterase type 5 inhibition on systemic and pulmonary hemodynamics and ventricular function in patients with severe symptomatic aortic stenosis.

BACKGROUND: Pressure overload resulting from aortic stenosis causes maladaptive ventricular and vascular remodeling that can lead to pulmonary hypertension, heart failure symptoms, and adverse outcomes. Retarding or reversing this maladaptive remodeling and its unfavorable hemodynamic consequences has the potential to improve morbidity and mortality. Preclinical models of pressure overload have shown that phosphodiesterase type 5 inhibition is beneficial; however, the use of phosphodiesterase type 5 inhibitors in patients with aortic stenosis is controversial because of concerns about vasodilation and hypotension. METHODS AND RESULTS: We evaluated the safety and hemodynamic response of 20 subjects with severe symptomatic aortic stenosis (mean aortic valve area, 0.7 ± 0.2 cm(2); ejection fraction, 60 ± 14%) who received a single oral dose of sildenafil (40 or 80 mg). Compared with baseline, after 60 minutes, sildenafil reduced systemic (-12%; P<0.001) and pulmonary (-29%; P=0.002) vascular resistance, mean pulmonary artery (-25%; P<0.001) and wedge (-17%; P<0.001) pressures, and increased systemic (13%; P<0.001) and pulmonary (45%; P<0.001) vascular compliance and stroke volume index (8%; P=0.01). These changes were not dose dependent. Sildenafil caused a modest decrease in mean systemic arterial pressure (-11%; P<0.001) but was well tolerated with no episodes of symptomatic hypotension. CONCLUSIONS: This study shows for the first time that a single dose of a phosphodiesterase type 5 inhibitor is safe and well tolerated in patients with severe aortic stenosis and is associated with improvements in pulmonary and systemic hemodynamics resulting in biventricular unloading. These findings support the need for longer-term studies to evaluate the role of phosphodiesterase type 5 inhibition as adjunctive medical therapy in patients with aortic stenosis.

Exercise echocardiography in rheumatoid arthritis: a case-control study.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased cardiovascular risk. METHODS: To assess the role of exercise echocardiography (EE) in the evaluation of patients with RA, follow-up (mean, 6.7+/-3.7 years) was retrospectively obtained in 159 patients with RA who underwent EE. Patients were matched for age, gender, and cardiovascular risk factors with 454 controls who underwent EE. RESULTS: Patients with RA were more likely to have positive results for ischemia on EE (odds ratio, 2.32; 95% confidence interval, 1.48-3.64; P=.0003). Rest and exercise wall motion score indexes were higher in the RA group (1.14+/-0.33 and 1.22+/-0.39, respectively, vs 1.06+/-0.18 and 1.10+/-0.24 in controls; P < .005 for each). Logistic regression adjusted for age revealed an increased odds ratio for myocardial ischemia of 1.06 (95% confidence interval, 1.02-1.11; P=.005) per year of RA. Five-year all-cause mortality in subjects with RA with myocardial ischemia on EE was 14.9%, compared with 4.3% in RA subjects without ischemia (P=.028). CONCLUSION: RA was associated with a 2-fold increased risk for myocardial ischemia on EE; risk increased with the duration of RA. Mortality was increased in patients with RA with ischemia on EE.

Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy (athlete's heart).

BACKGROUND: This study sought to determine whether strain rate imaging could distinguish between individuals with hypertensive left ventricular hypertrophy (LVH) and those with strength-training athletic LVH. METHODS: In all, 108 participants (30 hypertensive LVH, 30 strength-training LVH, 48 control) were enrolled. In addition to a baseline echocardiogram, strain, peak systolic strain rate (SR(S)), peak early diastolic strain rate (SR(E)), and peak late diastolic strain rate values were compared in the apical 4-chamber view. RESULTS: Athletes had no significant differences in strain, SR(S), SR(E), or peak late diastolic strain rate compared with control subjects (P = .11, .99, .85, and .09, respectively). Individuals with hypertensive LVH had significantly decreased strain, SR(S), and SR(E) (-16.8 +/- 3.2%, -0.99 +/- 0.15 s(-1), and 1.54 +/- 0.40 s(-1), respectively) compared with control subjects (-21.7 +/- 3.5%, -1.31 +/- 0.27 s(-1), and 2.35 +/- 0.57 s(-1), respectively; all P < .0001). CONCLUSION: Hypertensive LVH has significant longitudinal strain, SR(S), and SR(E) reductions versus control. The lack of these reductions in athletes suggests that strain rate imaging may have clinical use in discerning the physiologic LVH state.

Developmental changes in the orexin 2 receptor mRNA in hypoglossal motoneurons.

Hypothalamic orexin-containing neurons project to many CNS targets, including motoneurons. We assessed developmental changes in the expression of the orexin type 2 receptor (ORX2r) mRNA in hypoglossal (XII) motoneurons. Identified motoneurons were dissociated from 4- to 33-day-old rats and subjected to single-cell reverse transcription and PCR; nearly all contained the ORX2r mRNA. In 40 motoneurons studied using semi-nested PCR, and in another 39 subjected to quantitative, real-time PCR, the number of reverse-transcribed mRNA copies per cell was significantly higher around day 20 postnatally than at any other age. Thus, ORX may postsynaptically excite XII motoneurons, with the ORX2r mRNA production increased during the critical period for development of the rapid eye movement sleep and its disorder narcolepsy/cataplexy.