Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis?

Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.

Is the association between pulse wave velocity and bone mineral density the same for men and women? - A systematic review and meta-analysis.

BACKGROUND: Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However, the gender-specific association between baPWV and BMD remains unclear. The aim of our study is to evaluate the relationship between baPWV and BMD in men and women populations METHODS: A comprehensive search was conducted in electronic databases for relevant studies published between the 1th and 30rd of April 2023. Studies reporting the correlation between baPWV and BMD in both males and females were considered. A random-effects model was used to calculate pooled correlation coefficients (r). RESULTS: Relevant data for both genders were found in six articles. In all publications included in the meta-analysis, the total number of studied individuals was 3800, with 2054 women and 1746 men. Pooled correlation coefficient was -0,24 (95 % CI: -0.34; -0.15) in women population, and -0.12 (95 %CI: -0.16, -0.06) in men. CONCLUSIONS: Based on the published data, we found that baPWV is negatively correlated with bone density in women. However, in men we do not find such a relationship. These findings suggest the importance of considering gender-specific factors when assessing the cardiovascular and bone health relationship.

The Impact of COVID-19 on Carotid-Femoral Pulse Wave Velocity: A Systematic Review and Meta-Analysis.

COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid-femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help predict COVID-19-related cardiovascular (CV) complications. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies, and meta-analysis was performed. The study protocol was registered in PROSPERO (nr. CRD42023434326). The Newcastle-Ottawa Quality Scale was used to evaluate the quality of the included studies. Nine studies reported cfPWV among COVID-19 patients and control groups. The pooled analysis showed that cfPWV in COVID-19 patients was 9.5 ± 3.7, compared to 8.2 ± 2.2 in control groups (MD = 1.32; 95% CI: 0.38-2.26; p = 0.006). A strong association between COVID-19 infection and increased cfPWV suggests a potential link between the virus and increased arterial stiffness. A marked increase in arterial stiffness, a known indicator of CV risk, clearly illustrates the cardiovascular implications of COVID-19 infection. However, further research is required to provide a clearer understanding of the connection between COVID-19 infection, arterial compliance, and subsequent CV events.

Relationship between the Central and Regional Pulse Wave Velocity in the Assessment of Arterial Stiffness Depending on Gender in the Geriatric Population.

Artery stiffness is a risk factor for cardiovascular disease (CVD). The measurement of pulse wave velocity (PWV) between the carotid artery and the femoral artery (cfPWV) is considered the gold standard in the assessment of arterial stiffness. A relationship between cfPWV and regional PWV has not been established. The aim of this study was to evaluate the influence of gender on arterial stiffness measured centrally and regionally in the geriatric population. The central PWV was assessed by a SphygmoCor XCEL, and the regional PWV was assessed by a new device through the photoplethysmographic measurement of multi-site arterial pulse wave velocity (MPPT). The study group included 118 patients (35 males and 83 females; mean age 77.2 ± 8.1 years). Men were characterized by statistically significantly higher values of cfPWV than women (cfPWV 10.52 m/s vs. 9.36 m/s; p = 0.001). In the measurement of regional PWV values using MPPT, no such relationship was found. Gender groups did not statistically differ in the distribution of atherosclerosis risk factors. cfPWV appears to be more accurate than regional PWV in assessing arterial stiffness in the geriatric population.

New International Guidelines and Consensus on the Use of Lung Ultrasound.

Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.

Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis.

AIMS: Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). METHODS: we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. RESULTS: 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). CONCLUSION: our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.

Prevention and risk assessment of cardiovascular events in a population of patients with psoriasis and psoriatic arthritis.

Psoriasis is a chronic, inflammatory, often relapsing disease that is frequently associated with other diseases of similar pathogenesis. The multi-morbidity in the psoriasis population significantly impedes both diagnosis and implementation of appropriate preventive measures. However, the common denominator for this group of diseases is the inflammatory process that initiates the appearance of subsequent symptoms and health consequences, most of which can be avoided or alleviated by modifying the patient's lifestyle and incorporating appropriate treatment. Health consequences associated with systemic inflammation include cardiovascular incidents and other cardiometabolic diseases. This article was based on available publications on the onset, incidence, and prevention of cardiovascular disease in the psoriasis patient population.

Lost in Communication: Do Family Physicians Provide Patients with Information on Preventing Diet-Related Diseases?

Diet-related diseases remain leading causes of death in most developed countries around the world. The aim of the study was to compare opinions of patients and family physicians on receiving and providing recommendations about physical activity, diet and use of medication. Methods: The questionnaire study was conducted among patients of 36 primary health care clinics in Poland between September 2018 and February 2019. Patients and physicians were interviewed separately by trained researchers. Data from 509 patients and 167 family doctors were analyzed. Results: The median age of patients was 44 years (interquartile range: 29-55) and 70% were women. The majority of physicians were women (59%) and the median age was 37 years (IQR: 31-50). There was a significant difference between physicians' declarations on providing recommendations on diet (92% vs. 39%) and activity (90% vs. 37%) versus patients' declarations on receiving them. Conclusions: The results indicate that there is significant room for improvement in providing patients with proper recommendations on diet and physical activity by their family physicians. Primary care physicians should put more emphasis on clear communication of recommendations on diet and physical activity.

Using multiagent modeling to forecast the spatiotemporal development of the COVID-19 pandemic in Poland.

In the article, the authors present a multi-agent model that simulates the development of the COVID-19 pandemic at the regional level. The developed what-if system is a multi-agent generalization of the SEIR epidemiological model, which enables predicting the pandemic's course in various regions of Poland, taking into account Poland's spatial and demographic diversity, the residents' level of mobility, and, primarily, the level of restrictions imposed and the associated compliance. The developed simulation system considers detailed topographic data and the residents' professional and private lifestyles specific to the community. A numerical agent represents each resident in the system, thus providing a highly detailed model of social interactions and the pandemic's development. The developed model, made publicly available as free software, was tested in three representative regions of Poland. As the obtained results indicate, implementing social distancing and limiting mobility is crucial for impeding a pandemic before the development of an effective vaccine. It is also essential to consider a given community's social, demographic, and topographic specificity and apply measures appropriate for a given region.

Long-term spatial and population-structured planning of non-pharmaceutical interventions to epidemic outbreaks.

In this paper, we consider the problem of planning non-pharmaceutical interventions to control the spread of infectious diseases. We propose a new model derived from classical compartmental models; however, we model spatial and population-structure heterogeneity of population mixing. The resulting model is a large-scale non-linear and non-convex optimisation problem. In order to solve it, we apply a special variant of covariance matrix adaptation evolution strategy. We show that results obtained for three different objectives are better than natural heuristics and, moreover, that the introduction of an individual's mobility to the model is significant for the quality of the decisions. We apply our approach to a six-compartmental model with detailed Poland and COVID-19 disease data. The obtained results are non-trivialand sometimes unexpected; therefore, we believe that our model could be applied to support policy-makers in fighting diseases at the long-term decision-making level.

Type and reliability of information about coronavirus most frequently shared by social media users.

Objective: To identify, investigate and categorize the most frequently shared content related to COVID-19 by social media users. Methods: The BuzzSumo analytic tool was used to identify the most frequently shared content about COVID-19 between July and August 2020. They were then analyzed and classified into eight main categories according to their topic. Results: Among 120 articles that were shared 6,189,187 times in total during the analyzed period, the most popular were those that referred to methods for decreasing COVID-19 spread and characteristics. No myths or misinformation were found in the most frequently shared articles. The most popular content included humorous yet educational videos. Conclusions: The most frequently shared content by social media users is reliable and refers to prevention in the first place. As humorous videos about prevention attracted the most attention, it seems an attractive and potentially effective strategy to foster online preventive behaviors during the pandemic. Lay Summary: The most popular articles that were shared more than 6 million times in total during the analyzed period of time referred methods for decreasing COVID-19 spread and COVID-19 characteristics. The Internet and social media provide countless opportunities and audiences to deliver accurate knowledge and recommendations on COVID-19 and may contribute to fostering preventive and responsible behaviors.

Online Information of COVID-19: Visibility and Characterization of Highest Positioned Websites by Google between March and April 2020-A Cross-Country Analysis.

BACKGROUND: The WHO has used the term "infodemic" to describe the vast amount of false and true information that was making it difficult for people to find reliable information when they needed it. The infodemic spreads faster than COVID-19 itself. The main objective of the study was to characterize and analyze content about COVID-19 returned by Google during the pandemic and compare it between countries. METHODS: The study was conducted between 30 March and 27 April 2020. The information was searched through local Google websites using the "COVID-19", "Coronavirus", "SARS-CoV-2" and "fake news" keywords. The search was conducted in Australia, France, Germany, Italy, Poland, Singapore, Spain, UK and the USA. The total number of the analyzed webpages was 685. RESULTS: The most frequent types were News websites 47% (324/685) and Governmental 19% (131/685) while the least were Health portals 2% (17/685) and Scientific journals 5% (35/635), p < 0.001. United States and Australia had the highest share of Governmental websites. There was a positive correlation between the amount of preventive information and a number of SARS-CoV-2 infections in countries. The higher the number of tests performed, the higher was the amount of information about prevention available online. CONCLUSIONS: Online information is usually available on news and government websites and refers to prevention. There were differences between countries in types of information available online. The highest positioned (the first 20) websites for COVID-19, Coronavirus and SARS-CoV-2 keywords returned by Google include true information.

Comparison of the radial and brachial artery flow-mediated dilation in patients with hypertension.

BACKGROUND: Blood flow-mediated dilation (FMD) is a noninvasive assessment of vascular endothelial function in humans. The study of the FMD in hypertensive (HT) patients is an important factor supporting the recognition of the early mechanisms of cardiovascular pathologies, and also of the pathogenesis related to hypertension. OBJECTIVES: To investigate whether FMD measured on the radial artery (FMD-RA) using high-frequency ultrasounds can be used as an alternative to FMD assessed with the lower frequency system on the brachial artery in patients with HT. MATERIAL AND METHODS: The simultaneous measurements of FMD-RA and FMD measurements in the brachial artery (FMD-BA) were performed on 76 HT patients using 20 MHz and 7-12 MHz linear array probes, and were compared to the FMD measured in healthy groups. All quantitative data are presented as mean ± standard deviation (SD); the p-values of the normality and tests for variables comparisons are listed. The agreement of the FMD-RA and FMD-BA in HT patients was assessed with the Bland-Altman method, and using the intraclass correlation coefficient (ICC). In some statistical calculations, the FMD-RA values were rescaled by dividing them by a factor of 2. RESULTS: The mean FMD-RA and FMD-BA in HT patients were 5.16 ±2.18% (95% confidence interval (95% CI): [4.50%, 5.82%]) and 2.13 ±1.12% (95% CI: [1.76%, 2.49%]), respectively. The FMD-RA and FMD-BA values of HT patients were significantly different than those in respective control groups. The p-values of Mann-Whitney-Wilcoxon tests were less than 0.05. The Bland-Altman coefficient for both measurement methods, FMD-RA and FMD-BA, was 3%, and the ICC was 0.69. CONCLUSIONS: Our findings show that FMD-RA, supplementary to FMD-BA measurements, can be used to assess endothelial dysfunction in the group of HT patients. In addition, the FMD-RA measurements met the criteria of high concordance with the FMD-BA measurements.

Improving Colon Cancer Prevention in Poland. A Long Way Off.

The aim of this study was to analyse knowledge on colon cancer prevention among patients of primary care and identify their sources of information. The questionnaire study was conducted among patients of 36 primary healthcare clinics in Poland between September 2018 and February 2019. Patients were interviewed separately by trained researchers. Over 39% of the primary health patients declared that their knowledge about colon cancer prevention is unsatisfactory. Information about colon cancer prevention varied according to sex, age and BMI. Men declared lower level of knowledge than women: 46% of men thought it was unsatisfactory compared with 36% of women (p = 0.003). Preventive recommendations were more often provided to patients over 60 years old (p < 0.01). Overweight and obese patients were more likely to receive recommendations on diet (p < 0.001) and physical activity (p < 0.001) than patients with normal weight. The most common source of information on colon cancer prevention was Internet (68%) and medical doctors (60%). There is a need for developing colon cancer prevention policy. Crucial aspect includes educational programs aimed at improving patient's knowledge and involving medical staff. The policymakers should pay greater attention to cancer prevention policies and medical staff involved in prevention to quality of communication to make sure patients thoroughly understand information they are provided.

miRNA biomarkers in renal disease.

Chronic kidney disease (CKD), which is characterized by the gradual loss of kidney function, is a growing worldwide problem due to CKD-related morbidity and mortality. There are no reliable and early biomarkers enabling the monitoring, the stratification of CKD progression and the estimation of the risk of CKD-related complications, and therefore, the search for such molecules is still going on. Numerous studies have provided evidence that miRNAs are potentially important particles in the CKD field. Studies indicate that some miRNA levels can be increased in patients with CKD stages III-V and hemodialysis and decreased in renal transplant recipients (miR-143, miR-145 and miR-223) as well as elevated in patients with CKD stages III-V, decreased in hemodialysis patients and even more markedly decreased in renal transplant recipients (miR-126 and miR-155). miRNA have great potential of being sensitive and specific biomarkers in kidney diseases as they are tissue specific and stable in various biological materials. Some promising non-invasive miRNA biomarkers have already been recognized in renal disease with the potential to enhance diagnostic accuracy, predict prognosis and monitor the course of disease. However, large-scale clinical trials enrolling heterogeneous patients are required to evaluate the clinical value of miRNAs.

Association Between Physician Burnout and Self-reported Errors: Meta-analysis.

OBJECTIVES: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. METHODS: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. RESULTS: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%). CONCLUSIONS: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

Impact of continuous glucose monitoring on improving emotional well­being among adults with type 1 diabetes mellitus: a systematic review and meta­analysis.

INTRODUCTION: Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. OBJECTIVES: The purpose of this meta-analysis was to compare the emotional well-being of adults with T1DM who used CGM and those using conventional self-monitoring of blood glucose (SMBG). PATIENTS AND METHODS: The MEDLINE/PubMed, Cochrane Library / Embase, CINAHL, Scopus, Web of Science, and ProQuest databases were searched for relevant publications. Primary outcome measures were health-related quality of life, glycemic control, and fear of hypoglycemia. Randomized controlled trials and survey studies focused on the quality of life and fear of hypoglycemia among adult patients using CGM and SMBG were included in the analysis. RESULTS: The meta-analysis included 11 studies involving a total of 1228 patients with T1DM. Analysis of the Worry subscale of the Hypoglycemia Fear Survey indicated a reduction of hypoglycemia fear in CGM users compared with SMBG users (Cohen d = ­0.24; 95% CI, ­0.41 to ­0.07; mean difference, ­3.15; 95% CI, ­5.48 to ­0.82). Outcome analysis of studies including the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, ­0.18 to 0.63). The overall value of Cohen d equaled ­0.24 (95% CI, ­0.57 to 0.09), indicating a lack of effect of CGM use on improving HbA1c levels; however, after one of the studies was excluded from calculations, the reduction of HbA1c levels was significantly higher in CGM users (Cohen d = ­0.33; 95% CI, ­0.66 to 0.00; P = 0.047). CONCLUSIONS: This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.

Burnout, well­being, and self­reported medical errors among physicians.

INTRODUCTION: In recent years, healthcare systems around the world have been subject to profound changes driven by advances in technology, new regulations as well as demographic and societal trends. This volatile and stressful environment has had its consequences for healthcare organizations and their employees. The resulting phenomena of burnout or lowered well­being may affect key aspects of healthcare delivery on individual, organizational, and financial levels. OBJECTIVES: The objective of this paper was to investigate the level of burnout and well­being in a group of Polish physicians, its impact on errors, and associations with other factors. PATIENTS AND METHODS: This was a cross­sectional survey using a self­administered questionnaire with 65 questions and validated tools such as the Maslach Burnout Inventory and the World Health Organization-5 Well­being Index (WHO­5). Correlations between variables were investigated using Spearman rank correlation analysis. Univariable and multivariable logistic regression models were used to evaluate predictors of burnout and errors. The study included residents and physicians of various specialties. RESULTS: A total of 125 residents and physicians, mostly internists and cardiologists, participated in the study, out of which 84 (67%) were found to be burned out. The median WHO­5 score was 40 points. Two­thirds of all physicians admitted to making an error in the last 3 months, which was strongly  associated with burnout. CONCLUSIONS: The level of burnout among respondents was high and had numerous negative consequences that may affect the entire healthcare system. The results suggest there is an urgent need to address the problem of burnout among physicians.