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  • ISSN: 2333-6676
    Volume 8, Issue 3
    Review Article
    Pasquale Mone*, and Gaetano Santulli
    The review aim to investigate physical and cognitive decline after St-Elevation Myocardial Infarction (STEMI), in frail older adults. In the general critical care setting, about one-third of older adults are frails and frailty is associated with increased morbidity, mortality, and resource use, such as length of critical care unit stay and readmission rate. Cognitive and physical decline are very common in older populations, and their prevalence increases with age; in fact, dementia is a progressive and typically irreversible deterioration of cognitive function thypical of older adults.
    Frailty may increase the future risk of mild cognitive impairment (MCI), and all-cause dementia. It is known the association between cardiovascular diseases with functional and cognitive decline.
    Gait speed is a quick, inexpensive, reliable measure of functional capacity with well-documented predictive value for major health-related outcomes. Numerous studies have documented gait speed in older people. No studies are available on the correlations between 5-metres gait speed test and Mini Mental State Examination (MMSE), on frail STEMI patients. Here we reviewed the literature.
    Opinion
    Rakesh Gupta*
    As the number of COVID-19 cases in India near 6.4 millions and the country is under almost complete unlockdown, the numbers of cases have been increasing at a rapid pace of more than 0.08 million per day. Almost every person is moving around without wearing mask and not keeping social distancing, leading to further increase in spread of infection. At this time, it is very important for the healthcare professionals to take certain measures, which can help to save themselves in acquiring infection, so that they can help the community to fight against COVID-19 virus. The incidence of infection in healthcare workers in India is 87,000 with 573 deaths [1].
    Research Article
    Kurmanbekova BT*, Noruzbaeva AM, Osmankulova GE
    Aims: To evaluate the effect of metformin on the clinical course of ischemic etiology CHF in patients with prediabetes.
    Methods and Results: Open-label randomized clinical trial in 76 CHF patients was performed. Anthropometric, clinical, laboratory examinations at baseline and after 12 months of intervention were conducted. Insulin, aldosterone, Nt-proBNP levels determined by ELISA. All patients were on lifestyle modification and randomized for 2 groups with (n=39) and without (n=37) metformin. The primary outcomes were incidence of myocardial infarction, hospitalization for HF decompensation, all-cause death and conversion from prediabetes to diabetes. The secondary outcomes: CHF patients’ quality of life (QOL), neurohormonal, lipid profile and renal function. In metformin group revealed significant reduction of TC (p=0.042), LDL-C (p=0.009), nonHDL/HDL-C (p=0.005); improvement of kidney function (CKD-EPI) and daily proteinuria (p=0.000). In relation to neurohormonal profile in metformin group significantly decreased IR (p=0.0008), aldosterone (p=0.029), compared with no treatment group, but no statistical significance in Nt-proBNP was found (p=0.272). Also, there are dynamic improvement of LVEF (p=0.035), CHF patient’s QOL (p=0.037) and 6-minute walking test results (p=0.000). Metformin treatment significantly associated with all-cause death decreasing (p=0.01), conversion from prediabetes to T2DM (p=0.008); regarding to MI and readmission for HF decompensation two groups did not differ (p=0.422).
    Conclusions: Such beneficial effect of metformin on CHF course may be required to consider metformin as a part of optimal medical treatment in patients with CHF already at the stage of prediabetes.
    Trial registration number: ClinicalTrials.gov NCT04549415 (registered 14 September 2020).
    Ali Serhal*, Pascale Aouad, Julie Blaisdell, and James Carr
    Background: Thoracic aortic aneurysm (TAA), is a common condition that requires imaging follow-up to evaluate for complications and intervention timing. In asymptomatic patients, TAA evaluation is done with routine follow up of the aortic dimensions.
    Purpose: To compare 3D volumetric measurement and 2D diameter measurement in surveillance of TAA using computed tomography angiography (CTA), in asymptomatic patients.
    Materials and methods: Forty patients (mean age 66.2 y, 29 males), undergoing surveillance of TAAs was retrospectively identified. Quantitative analysis was performed by measuring the diameters at sinus of Valsalva (SOV), and mid ascending aorta (MAA), using standard technique and measuring the volume of the ascending aorta from the annulus to the proximal arch level by two radiologists on a baseline and follow up scans.
    Results: The mean interval time between baseline and follow up exams was 2.3 ±1.5 years. There was significant diameter growth at the level of the MAA (p=0.0056), but not at the level of the SOV (p=0.08). There was significant growth of the ascending thoracic aorta volume (p=0.0001). There was excellent intra-rater and inter-rater agreement. The percent growth of the volume measurement was 2.7 times greater than the MAA percentage growth (5.1% vs 1.9%, P < 0.001) and 1.8 times greater than the diameter of maximal growth percentage growth (5.1% vs 2.9%, P < 0.001) over the entire follow-up period.
    Conclusions: Volumetric measurement of the ascending aorta is a reproducible method that offers greater sensitivity than conventional 2D measurements for detection of the growth rate of the ascending thoracic aorta.
    Steven D. Culler*, April W. Simon, Phillip P. Brown, Marc R. Katz, Aaron D. Kugelmass, and Matthew R. Reynolds
    Background: Impella® was approved for mechanical circulatory support (MCS) in 2008. The purpose of this study is to report observed and risk-adjusted adverse events among Medicare Beneficiaries (MBs), with a percutaneous coronary intervention (PCI), and cardiogenic shock receiving Impella® versus intra-aortic balloon pump (IABP).
    Methods: The Medicare Provider Analysis and Review file for calendar years 2016 through 2018 is the data source. The study population consists of 21,968 MBs diagnosed with cardiogenic shock, underwent PCI and required MCS (Impella® or IABP). Adverse events included vascular complications, acute renal failure, new onset hemodialysis, sepsis, stroke, and mortality over three time periods. Adverse event rates are reported as observed and risk-adjusted for the entire study population and for a one-to-one propensity matched sample of 12,656 MBs.
    Results: The matched sample indicated that 76.0% of the MBs receiving Impella® experienced at least one of the in-hospital adverse events compared to 44.2% of MBs receiving IABP treatment. More than 20% of MBs in the matched sample experience a vascular complication (Impella® arm=38.7% vs. IABP arm = 21.3%, p=0.001), acute renal failure (Impella® arm=24.3% vs. IABP arm = 21.0%, p=0.001), and in-hospital mortality (Impella® arm=44.3% vs. IABP arm = 33.6%, p=0.001). MBs receiving Impella® had higher risk-adjusted odds of any inpatient complication (OR 2.17, 95% CI 2.03 – 2.33, p<0.001), and 90-day mortality (OR 1.52, 95% 1.43 – 1.62, p<0.001) than MBs receiving IABP treatment.
    Conclusions: MBs with cardiogenic shock undergoing PCI receiving Impella® were more likely to experience adverse events than MBs receiving IABP treatment.
    Jerry Jacob*, Ranjana Tryambake, and Vinita Jamdade
    Any change in electrical conduction or automaticity of the heart causes disturbances in heart rate and rhythm, often referred to as cardiac arrhythmias.
    Objectives: To assess the knowledge regarding interpretation of cardiac arrhythmias and it’s management among staff nurses before and after planned teaching program, to compare the pre-test and post-test knowledge scores regarding interpretation of cardiac arrhythmias and it’s management among staff nurses and to associate the pre-test score with selected demographic data.
    Material and methods: A quantitative research approach using pre-experimental pretest post test design was adopted for the study. Sister Callista Roy’s adaptation model was adopted in the study, Non-Probability Convenient Sampling technique with 100 samples were selected from selected hospitals of Pune city. A self structured questionnaire was used to collect the data during September2017 to October 2017 to obtain the knowledge level.
    Results: Findings of the study shows that majority of participants were females (65%), working in critical care units (63%), with Revised Diploma in General Nursing and Midwifery (78%), in the age group of 20-25 years (52%), having attained no in-service education regarding cardiac arrhythmias (77%). There was no association between knowledge scores and selected demographic variables. Pre test knowledge scores; in the present study 64% of the samples had average knowledge regarding interpretation of cardiac arrhythmia’s and its management Post test knowledge scores increased after planned teaching program. 88% of samples had good knowledge regarding interpretation of cardiac arrhythmia’s and its management.
    Conclusion: A majority of nursing staff in ICU’s can be helpful in prevention of critical condition and promotion of health. Thus arises the need to train nurse’s through educational programs which will benefit in early detection and diagnosis of cardiac arrhythmia’s, reducing the mortality rate and improving quality of care provided.
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