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  • ISSN: 2333-6676
    Volume 5, Issue 1
    Research Article
    Kamyar M. Hedayats*, Benjamin M. Schuff, Jean Claude Lapraz, Tiffany Barsotti, Shahrokh Golshan, Suzi Hong, Barry H. Greenberg, and Paul J. Mills
    Background: Chronic heart failure (CHF) is an inflammatory disorder. Elevated Neutrophil-to-Lymphocyte ratio (NLR) is associated with inflammation and increased morbidity and mortality in various disorders including CHF. NLR is a non-specific, quantitative biomarker assessment. It does not allow for a personalized approach to treatment. A global systems approach to biomarker assessment is quantitative and qualitative, contextualizing basic data into larger sets of meaning. Such a system may provide greater meaning to the NLR, increasing its clinical utility in CHF. Endobiogeny is a global systems theory. It claims to be able to model complex physiology through biomarkers, offering context-rich interpretations of data for meaningful clinical applicability. In Endobiogeny, NLR is referred to as the Genito-Thyroid index (GT).
    Aim: The NLR has never been studied in ambulatory CHF patients. The first aim of this study was to determine if NLR is elevated for ambulatory CHF patients versus controls. The second was to determine if the endobiogenic interpretation of the NLR as the GT index is consistent with current pathophysiologic models.
    Methods: A retrospective observational case-controlled study was performed in 93 patients with New York Heart Association class II-III heart failure patients and 104 individuals with no cardiovascular pathology as a control group. Two biomarkers, percent neutrophils and percent lymphocytes, were entered into the Biology of Functions modeling software, from which a direct index was produced to model an aspect of the heart failure terrain. All calculations were performed using SPSS Inc. (version 22.0) and analyzed by univariate or multivariate analysis of covariance.
    Results: NLR or, GT index (normal 1.5-2.5) was elevated in CHF patients vs. control (2.81 vs 2.01, p<0.001).
    Conclusions: NLR, or, GT index, when elevated reflects a hyperimmune response to an aggression. CHF is associated with elevated immune activity. Ambulatory CHF patients show signs of a hyperimmune response even when clinically stable. The endobiogenic explanation of the NLR is consistent with current pathophysiological models of CHF. Future studies should explore if a certain cutoff value of the GT index is predictive of future deterioration in CHF patients. Future studies should evaluate other endobiogenic indexes for their clinical relevance in CHF.
    Taizen Nakase* and Tatsuya Ishikawa
    Objective: This study was aimed to reveal the possibility of newly emerged hemorrhagic complication in acute ischemic stroke patients after the introduction of oral anticoagulants, including warfarin and directoral anticoagulants (DOACs).
    Methods:
    Acute ischemic stroke patients who admitted to the hospital within 24 hrs following onset were consecutively screened between July 2012 and June 2013. Then, patients with oral anticoagulant as secondary stroke prevention introduced within 2 weeks were enrolled in this study (n=95). The hemorrhagic complication following the institution of anticoagulants was assessed by repeated brain CT or MRI.
    Results: Warfarin was prescribed to 34patients and DOACs were prescribed to 61patients (dabigatran 27and rivaroxaban 34). Patients with DOACs showed significantly milder deficits compared with warfarin (p<0.01: NIH Stroke Scale 5.5and 10.3, respectively). Regarding the newly emerged hemorrhagic complication following the institution of anticoagulants, its frequency was not significantly different between warfarin and DOACs (16.1% and 23.9%, respectively). The hemorrhagic complication was not observed, if anticoagulation was started later than4, 5and 6 days following onset in the small, moderate and large infarctions, respectively. No recurrent ischemic stroke was observed during the observation period.
    Conclusion: Not only warfarin but also DOACs could be safely started from the acute phase of stroke depending on the lesion size in the real clinical world. Further study might need to confirm our findings.
    Clinical Image
    Sang-Hoon Seol*
    A 65-year-old woman with a past history of hypertension who was referred to our hospital for evaluation of dyspnea, fatigue.She was diagnosed polycystic kidney disease for 15 years and started hemodialysis using left forearm at 55 years of age.
    Review Article
    Mahyar Pourriahi, Mahbod Pourriahi, and John Kassotis*
    Despite significant advances, the incidence of sudden cardiac death (SCD) remains high. With greater public awareness and ease of access to defibrillators (e.g. AEDs), we are hopeful that both the morbidity and mortality of SCD will improve significantly. However, we believe the greatest impact will be derived from focusing our attention on identifying and managing patient’s known to have a predisposition for SCD. Given the improvements in technology and refinements in implantation techniques, the placement of implantable cardioverter defibrillator has emerged as the standard of care for primary and secondary prevention. The purpose of this review is to identify for the reader which patients are at high risk for SCD and subsequent management.
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