Active gaming and self-paced exercise: A self-determination perspective
Published on: 23rd March, 2018
OCLC Number/Unique Identifier: 7493576458
Purpose: This study aimed to identify physical activity, enjoyment, and factors for future activity between an active video game (AVG) condition and self-paced exercise (SPE) among college-aged students.
Methods: Thirty college-aged volunteers (age=22±1.68 years) completed 4-45 minute physical activity sessions (2 AVG; 2 self-paced). A survey and a brief structured interview followed.
Results: Overall, participants expended more calories, accumulated more steps, and more physical activity during SPE; however, participants in the AVG condition met daily exercise recommendations. The majority of participants (81%) enjoyed playing the AVG. Autonomy and competence were found as common themes among those who preferred the SPE condition; whereas, lack of knowledge and exercise variety were emergent themes among those who preferred AVG.
Conclusions: This study provides evidence that college students could meet daily exercise recommendations by participating in AVG interventions; although AVGs that provided autonomy and allowed users to demonstrate competence would be preferable.
Chondrogenic re-differentiation potential of chondrocytes after monolayer culture: Comparison between osteoarthritis and young adult patients
Published on: 27th March, 2019
OCLC Number/Unique Identifier: 8049578277
Purpose: Monolayer passage of chondrocytes results in dramatic phenotypic changes. This “de-differentiation” is expected to restore the chondrogenic properties such as “re-differentiation” in autologous chondrocyte implantation (ACI). The purpose of this study was to compare the chondrogenic re-differentiation potential of chondrocytes, from osteoarthritis (OA) patients and young adult patients, after monolayer culture.
Methods: Chondrocytes from five old patients with knee OA (OAC) and five young patients with recurrent shoulder dislocation (non-OAC) were used. The chondrocytes from passages 1 to 3 were analyzed for the expression of cell surface markers (CD73, CD90, CD105, and CD44) by flow cytometric analysis. Chondrocytes of passage 4 were cultured as pellets for re-differentiation and evaluated histologically. Real-time PCR were performed to measure the chondrogenic related genes transcriptional levels.
Results: OAC and non-OAC had comparable positive ratios for CD44, CD73, CD90, and CD105. The expression of CD105 was upregulated from passage 1 to passage 3 in OAC, and it increased at the same level as in non-OAC during passage 2 and 3. The expression of COL2 decreased from passage 1 to passage 3 in both the groups. There were no statistical differences in the Bern Scores between OAC and non-OAC.
Conclusion: The chondrocytes from OA patients and young adult patients had chondrogenic re-differentiation potential. The changes in cell surface markers and chondrogenic related genes showed similarity for both the groups. Our findings suggest that OAC can become the cell source for ACI.
Bergamot Polyphenolic Fraction supplementation improves metabolic balance, endothelial function and maximal oxygen uptake in athletes
Published on: 10th April, 2018
OCLC Number/Unique Identifier: 7666322929
Background: The study aimed to evaluate the effects of a 4-week Bergamot Polyphenolic Fraction (BPF Gold; Bergamet Sport) supplementation on serum nitric oxide (NO), asymmetric dimethyl-arginine (ADMA), Endopat indices of endothelial function and maximal oxygen uptake (V_ O2max) of athletes.
Methods: The effects of dietary supplementation (BPF Gold, 650 mg twice a day for 4 weeks) and placebo administration on flow-mediated dilatation (via Endopat measurements), serum markers (NO, ADMA), lipid profile, and V_ O2max were analysed in 30 athletes both before and after dietary protocols.
Results: Significant differences between pre- and post-intervention baseline NO levels were observed after BPF Gold dietary protocol. Higher post-intervention baseline NO level was observed after BPF Gold diet compared with placebo. Moreover BPF Gold Sport increased baseline NO concentration (ΔNO). The positive correlation was observed between baseline post-intervention NO concentration and maximal oxygen uptale and also between ΔNO and ΔVO2max in response to BPF Gold supplementation. There was an association between a higher Edopat values of endothelial function and higher V O2max after Bergamet Sport diet compared with lower values of placebo.
Conclusions: These findings suggest that an increase in NO release in response to BPF Gold Sport supplementation may play a central role in cardiovascular adaptive mechanisms and enhanced exercise performance in athletes.
Head impact exposure comparison between male and female amateur rugby league participants measured with an instrumented patch
Published on: 29th April, 2019
OCLC Number/Unique Identifier: 8163924025
Background: Epidemiological studies report that females experience greater rates of concussion when compared with males. Biomechanical factors may result in greater post-impact head velocities and accelerations for a given force for females when compared with males.
Purpose: To quantify the magnitude, frequency, duration and distribution of impacts to the head and body in rugby league match activities for females versus males.
Design: Prospective descriptive epidemiological study.
Methods: 21 female and 35 male amateur rugby league players wore wireless impact measuring devices (X2Biosystems; xPatch) behind their right ear over the mastoid process during match participation across a single season. All impact data were collected and downloaded for further analysis.
Results: Male amateur rugby league players experienced more head impacts than female amateur rugby league players (470 ±208 vs. 184 ±18; t(12)=-3.7; p=0.0028; d=1.94) per-match over the duration of the study. Male amateur rugby league players recorded a higher median resultant Peak Linear Acceleration (PLA(g)) (15.4 vs. 14.6 g; F(824,834)=51.6; p<0.0001; t(1658)=-3.3; p=0.0012; d=0.10) but a lower median resultant Peak Rotational Acceleration (PRA(rad/s2) (2,802.3 vs. 2,886.3 rad/s2; F(831,827)=3.1; p<0.0001; t(1658)=5.7; p<0.0001; d=0.13) when compared with female amateur rugby league players
Conclusion: Females recorded lower median values for PLA(g) and Head Impact Telemetry severity profile (HITSP) for all positional groups but had a higher PRA(rad/s2) for Hit-up Forwards (HUF) and Outside Backs (OSB’s) when compared with male HUF and OSB’s. Females also recorded more impacts to the side of the head (48% vs. 42%) and had a higher 95th percentile resultant PRA(rad/s2) (12,015 vs. 9,523 rad/s2) to the top of the head when compared with male rugby league players.
The science of enduring pain. What can athletes and chronic pain patients learn from each other?
Published on: 11th July, 2019
OCLC Number/Unique Identifier: 8192130179
“It isn’t the mountains ahead to climb that wear you out; it’s the pebble in your shoe.” Muhammad Ali
What mind strategies can an endurance athlete use to get their body that bit further or faster, to be a finisher? At “top-level” sport, some say it’s all in the mind!! When we push ourselves to the limit, we experience adversity. How and if we overcome that, will define us, and our achievements.
“Adversity causes some men to break; others to break records.” William A. Ward (Inspirational Writer)
Triathlon challenge – from craggy to crazzy a different kind of pain management program
Published on: 23rd July, 2019
OCLC Number/Unique Identifier: 8192141397
Ironman Wales sept 14th 2014
Sea swim (2.4 mile), bike ride (112 mile) and Marathon (26 mile), all in one day!
There are lessons that the 7.8 million UK Chronic Pain patients can learn from the world of endurance sports, and vice versa [1]. The training, psychological tools and strategies used by athletes to complete an endurance event, are equally relevant for those with chronic pain, who wish to regain some form of “normal” life if treatment therapies have failed [2,3].
This is my reflection of how, using some of the techniques involved in Pain Management Programs, I trained for an Ironman Triathlon in just over one year.
Final solution in femoroacetabular impingement - Threaded cups in hip revision surgery 2002-2012
Published on: 23rd October, 2018
OCLC Number/Unique Identifier: 7900083791
Purpose: Here, we report the complications of endoprosthesis with threaded cups according to our application in cases of complicated acetabulum (hip revisions and femoroacetabular impingement (FAI)).
Methods: A total of 504 patients was analyzed, including 189 men and 315 women. For re-implanted patients (n = 49), the mean time to re-implantation was 6.3 years and the average age at re-implantation was 54.7 years. For censored patients (n = 455), the mean time to censoring was 5.5 years and the average age of the implant was 55.7 years. Among the patients that were censored, 77 died and 378 patients did not experience an event necessitating re-implantation.
Results: For the total study population, the Kaplan-Meier estimate of 5 year survival is 0.94 and of 10 year survival is 0.85. 90% of the implants survived 7 years, 80% of the implants survived almost 12 years and 70% of implants survived almost 15 years. Kaplan-Meier survival analysis suggests that men have higher survival than women. Age of the patient at the time of implant was not a statistically significant factor for re-implantation (p value = 0.21) but sex was (p value = 0.02). Women had 2.25 times more risk of being re-implanted than men.
Conclusions: In our case series, the failure rate, as a result of aseptic loosening, was 7.4% (n = 51). More than half the failure cases (56%) required re-implantation. Over one-third (37%) of the primary arthrosis cases, were found to be FAI, lessening the frequency of diagnosis of the former. In our clinic, the threaded cup seems to be indispensable in hip revision surgery and in treating FAI.
Contractions of athlete’s foot and its muscle oxygenation
Published on: 5th December, 2018
Sustained isometric contractions of skeletal muscles produce intramuscular pressures that leads to blood flow restriction. In result an active muscle feels deficit of oxygen what bring to muscle fatigue. In another side during exercise we have physiological contradiction between raising of oxygen demand by working muscle and restriction of blood flow due to vessel pressing. To clarify this issue many research has been performed based mainly on measurement of blood flow in muscle tissue. The purpose of this study was to assess real-time changes in muscle oxygenation during a sustained isometric contractions of dorsiflexor muscle of low (30%), moderate (60%) and submaximal (90%) intensity. Experiments were conducted using the subject’s dominant (right) leg. Volunteers was recruited from eight male students of USIPC (age: 19±2 years, weight: 75±6 kg). Tissue oxygenation index (StO2) were recorded from the tibialis anterior using NIRS device (NONIN). Saturation was higher at 30% compared with both 60% and 90% MVC at all time points after start exercise and higher at 60% than 90%. Oxygen consumption (VO2) permanently increased from slow (30%) to moderate (60%) and submaximal contractions. After cessation of the each contraction there was a large and immediate hyperemic response. Rate of StO2 increasing after effort cessation what reflects the resaturation of hemoglobin which depend on integrity and functionality of vascular system and reflects blood vessel vasodilation. StO2 restoration rate permanently increased from slow (30%) to moderate (60%) and submaximal contractions too. At last on final stage of experiment arterial occlusion test has been performed to determine the minimal oxygen saturation value in the dorsiflexors. Oxygen saturation reached a 24±1.77% what is significantly higher than StO2 after 60 and 90%MVC.
So, we can conclude that oxygen saturation at 60% and 90% MVC are similar and sharply decreased after start of exercise. It means that after 60% MVC take place occlusion of blood vessels due to intramuscular pressure. Oxygen consumption of active muscle increased depend on intensity of exertion according to increasing of oxygen demand. StO2 resaturation rate (Re) permanently increased from slow (30%) to moderate (60%) and to submaximal contractions. Re increasing after effort cessation reflects the resaturation of hemoglobin which depend on integrity and functionality of vascular system and reflects blood vessel vasodilation.
Role of physical activity in cancer survival and recurrence: A narrative review from relationship evidence to crucial research perspectives
Published on: 12th December, 2018
OCLC Number/Unique Identifier: 7964792160
Purpose: The benefits of Physical Activity (PA) considered as a major supportive care in cancer patients, on survival, and recurrence risk is largely disseminated in public communication. However, these data must be taken with caution. The main objectives were to review the evidence and limits of studies reported regarding the post-diagnosis PA role on cancer survival and recurrence risk to secondly discuss of research perspectives on PA programs.
Method: The narrative review included all published or ongoing studies in English during the last 20 years related to PA, survival and recurrence risk with a systematic search on main databases.
Results and discussion: The current evidences regarding the PA role on survival and recurrence risk were only based on cohort studies, mainly in breast cancer. The major methodological limits identified as the lack of PA change assessment, PA level assessed largely by self-reported methods and the significant inter- but also intra- variability make the interpretation of data very. Beyond the use of rigorous RCT, the major issue is to develop adapted and personalized interventions to progressively increase PA level overtime in cancer survivors.
Conclusion: Despite the lack of causal relationship between post-diagnosis PA, survival and recurrence risk, the review underlines several interesting research perspectives. The future PA interventions, using innovative tools and integrated to the “real-life” will argued for the potential antitumoral PA role growing in literature.
The effects of physiotherapy and rehabilitation on Pallister-Killian Syndrome: A case report
Published on: 20th December, 2018
OCLC Number/Unique Identifier: 7964755732
The aim of the paper is to determine the effects of physiotherapy and rehabilitation (PHTR) on a child with Pallister-Killian Syndrome (PKS). Gross Motor Function Measure (GMFM) and duration of grasping ping pong ball were the primary outcome measures which were conducted at the beginning, 12th, and 24th month. Neurodevelopmental Therapy and Sensory Integration Therapy were used as intervention methods. The most increase with around 50% was acquired in Section A of the GMFM. Duration of holding a ping pong ball gradually increased. As a result, this is the first paper presenting a PHTR shedule and its results in a child with PKS.
The effect of a European-based exercise program upon the health-related physical fitness of individuals with intellectual disabilities: The alive and kicking perspective
Published on: 24th December, 2019
OCLC Number/Unique Identifier: 8505524065
The present study examined the effect of the European-Based ‘Alive and Kicking’ exercise program on the health-related physical fitness of individuals with (Experimental Group: EG) and without (Control Group: CG) (Intellectual Disability: ID). The Self-Determination Theory: SDT, guided both the 6-month preparatory phase and the 9-month exercise program, which was conducted in five separate European countries (Cyprus, France, Greece, Portugal and Spain). The total sample (n = 200, 54% males and 46% females) comprised of 168 individuals with ID (age: 26.54 years, + 7.78) and 32 individuals without ID (age: 25.81 years, + 8.73) respectively. The statistical analyses revealed that the ID group’s performance (EG) improved significantly in a range of health-related physical fitness variables (sit & reach, pushups, sit ups, long jump, ½ mile walk/ run). In turn, the participants from the CG improved mainly in muscular endurance (sit ups and pushups). The results are discussed in accordance with SDT and the dairies kept from the staff involved (coaches and psychologists) during the 9–month intervention. The present findings, although subjective to certain limitations, are encouraging, given the large-scale, real-world nature of the research design, and provide evidence supporting the integration of theoretical strategies enhancing motivation into traditional coaching programs for individuals with ID.
Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports
Published on: 16th March, 2017
OCLC Number/Unique Identifier: 7286354252
Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identified head injuries were physician-confirmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identification and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.
Left Atrial Remodeling is Associated with Left Ventricular Remodeling in Patients with Reperfused Acute Myocardial Infarction
Published on: 7th December, 2016
OCLC Number/Unique Identifier: 7286353354
Background: Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied.
Methods: We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling.
Results: LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5- 31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariateanalysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001).
Conclusions: Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term reflects better than standard echocardiographic indices LV diastolic filling impairment.
Mid-Ventricular Ballooning in Atherosclerotic and Non-Atherosclerotic Abnormalities of the Left Anterior Descending Coronary Artery
Published on: 30th December, 2016
OCLC Number/Unique Identifier: 7286428119
In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents.
Concentration Polarization of Ox-LDL and Its Effect on Cell Proliferation and Apoptosis in Human Endothelial Cells
Published on: 30th December, 2016
OCLC Number/Unique Identifier: 7286351432
Background: Flow-dependent concentration polarization of native LDL is important in the localization of atherogenesis. However, ox-LDL plays a more important role than n-LDL in atherogenesis by inducing cell proliferation and apoptosis. We hypothesized that concentration polarization of ox-LDL may adversely affect vascular beds due to its toxicity to endothelial cell (EC) lining.
Methods: Using a parallel-plate flow chamber technique, we studied water filtration rate and wall concentration of ox-LDLs EC monolayers cultured on permeable or non-permeable membranes. ECs cultured on permeable and non-permeable membranes were examined in terms of cell viability, ox-LDL uptake, LOX-1 expression and cell apoptosis (Cytochrome c and Bcl-2 expression). We observed that the wall concentration of ox-LDL was about 16% higher in the permeable group than in the permeable group (P<0.05). Cell proliferation (MTT assay) increased in response to low concentration of ox-LDL (1-5 μg/ml), and fell drastically in response to higher concentration; all these changes were more pronounced in the permeable group than in the non-permeable group. The uptake of ox-LDL and LOX-1 expression by ECs were also significantly higher in the permeable group than in the non-permeable group of cultured cells.
Conclusions: These observations suggest that concentration polarization of ox-LDL occurs in an artery that is permeable to water, and ox-LDL concentration polarization can enhance ox-LDL accumulation into the arterial wall and accelerate EC proliferation at low concentrations and apoptosis at high concentrations, possibly via LOX-1 expression.
Short and Medium-Term Evaluation of Patients in Coronary Post-Angioplasty: Préliminary results at the Cardiology Department of the Hospital University Aristide Le Dantec of Dakar (Senegal): Study on 38 Cases
Published on: 20th February, 2017
OCLC Number/Unique Identifier: 7286354250
Introduction: Coronary angioplasty is a safe therapeutic method for coronary disease. However, its major obstacles remain the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR). The aim of this study was to evaluate the short-term and medium-term results of coronary angioplasty patients in the cardiology department of Aristide Le Dantec hospital in Dakar.
Methodology: It was a longitudinal, descriptive and analytical study over a period of 12 months (April 2014 to April 2015) with a follow-up at 6 months. Was included any patient who had a coronary angioplasty with stent placement.
Results: Thirty-eight patients had been included with a male predominance and a sex ratio of 5.32. The average age was 57.94 years. Cardiovascular risk factors were mainly smoking (57.9%) and coronary heredity (42.1%), followed by hypertension (39.5%) and diabete (34.2%). The indications for angioplasty were acute coronary syndromes TS(+) and TS(-) respectively (50%) and (23.7%) and stable angina (26.3%). The right femoral approach was almost exclusive (97.4%). Coronary angiography revealed a predominance of anterior interventricular affection (84.2%). Type B lesions were the most frequent (68.4%). The single-truncal valve affection was predominant (76.3%). Direct stenting accounted for 63.2% of procedures. Twenty-one bare stents (55.3%) and 17 active stents (44.7%) were implanted. The results were excellent (94.7%). One case of acute stent thrombosis was noted. Echocardiography of dobutamine stress during follow-up was positive in 04 patients (12.5%). The control coronary angiography performed in two patients revealed an ISR. The predictive factors for restenosis were dominated by a deterioration in the segmental kinetics (p=0.009), in the diastolic function (p=0.002), the systolic function (p=0.003), a high post angioplasty troponin (p=0.004), the presence of calcifications (p=0.004) and a high SYNTAX score (p=0.021).
Conclusion: According to these results, Angioplasty is an effective therapy for coronary disease. However, a correct intake of double platelet antiaggregants and clinical and non-invasive screening are required for follow-up to avoid stent thrombosis or restenosis.
Indications and Results of Coronarography in Senegalese Diabetic Patients: About 45 Cases
Published on: 20th February, 2017
OCLC Number/Unique Identifier: 7286426513
Introduction: Coronary disease accounts for 75% of diabetic mortality. Coronary angiography reveals lesions that are often diffuse, staggered and multi-truncated. The objective of this study was to determine the indications and results of coronary angiography in diabetic patients.
Method: This is a cross-sectional, descriptive and analytical study which took place from May 2013 to July 2015 at the cardiology clinic of the Aristide Le Dantec hospital. We have included all diabetics who have benefited from coronary angiography by studying clinical and paraclinical data, particularly coronary angiography ones.
Results: During this period, 400 patients had coronary angiography, including 45 diabetics, a hospital prevalence of 11.25%. The average age of our patients was 62.27 y/o with extremes of 44 and 85 y/o. The sex ratio was 1.6 in favor of men. Diabete was revealed in 42 patients. Almost all patients were type II diabetics (44 patients) since 9.94 years in average. The associated cardiovascular risk factors were hypertension 66.7% and dyslipidemia 49.6%. Only 4 patients had typical chest pain. The electrocardiogram was abnormal in 84.4% of cases with 26 cases of SCA ST +. Coronary angiography was abnormal in 37 patients with significant stenosis in 30 patients. A single-truncular lesion was found in 14 cases, 8 had bi-truncular and other 8 had tri-truncular one. The anterior interventricular artery and the segment II of the right coronary were the most affected branches. Concerning the management, 14 patients had angioplasty with an active stent, 8 patients had medical treatment alone and 9 patients had coronary artery bypass surgery. Accidents occured for 4 patients, two of whom had arterial spasm, one of a vagal discomfort and another had an occlusion of the circumflex that led to the implantation of a stent.
Conclusion: Diabetes is accompanied by progressive coronary atherosclerosis, which has an adverse effect on patients' prognosis. Tri-truncal affection and indications for coronary artery bypass surgery are common
Procedure utilization, latency and mortality: Weekend versus Weekday admission for Myocardial Infarction
Published on: 19th May, 2017
OCLC Number/Unique Identifier: 7286355059
Background: Due to variations in hospital protocols and personnel availability, individuals with myocardial infarction admitted on the weekend may be less likely to receive invasive procedures, or may receive them with a greater latency than those admitted during the week. Whether or not this occurs, and translates into a difference in outcomes is not established.
Method: Using the Nationwide Inpatient Sample (2008-2011) database, we identified all patients admitted with a principle diagnosis of acute myocardial infarction. They were stratified by weekend or weekday admission. Baseline clinical characteristics, procedure utilization and latency to procedure were compared, and logistic regression models were constructed to assess the relationship between these variables and in-hospital mortality.
Results: Patient demographics and provider-related characteristics (hospital type, geography) were similar between weekend and weekday admission for myocardial infarction. Adjusted for covariates, we found that the odds of mortality for a weekend admission are 5% greater than for a weekday admission (OR: 1.05; 95% CI: 1.01, 1.09, p=0.009). For the utilization of an invasive procedure, we found that the odds of receiving a procedure for a weekend admission were 12% less than the odds for a weekday admission, adjusted for the other covariates (OR: 0.88; 95% CI: 0.86, 0.91, p<0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p<0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87).
Conclusion: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality.
Thrombolysis, the only Optimally Rapid Reperfusion Treatment
Published on: 23rd June, 2017
OCLC Number/Unique Identifier: 7286427398
Thrombolysis with tissue plasminogen activator (tPA) has been plagued by inadequate efficacy and a high risk of intracranial hemorrhage (ICH), which led to its replacement by procedures like percutaneous coronary intervention (PCI) whenever possible. Since this requires hospitalization, it is time-consuming, and compromising salvage of brain tissue and myocardium. Thrombolysis is the only first-line treatment that can provide sufficiently timely treatment for optimal recovery of organ function. However, for this potential to be realized, its efficacy and safety must be significantly improved over the current method. By adopting the sequential, synergistic fibrinolytic paradigm of the endogenous system, already verified by a clinical trial, this becomes possible. The endogenous system’s function is evidenced by the fibrinolytic product D-dimer that is invariably present in blood, and which increases >20-fold in the presence of thromboembolism. This system uses tPA to initiate lysis, which is then completed by the other fibrin-specific activator prourokinase (proUK). Since tPA and proUK in combination are synergistic in fibrinolysis, it helps explain their efficacy at their low endogenous concentrations.
Incidence of symptom-driven Coronary Angiographic procedures post-drug-eluting Balloon treatment of Coronary Artery drug-eluting stent in-stent Restenosis-does it matter?
Published on: 29th June, 2017
OCLC Number/Unique Identifier: 7286426167
Objectives: The clinical impact of drug-eluting balloon (DEB) coronary intervention for drug-eluting in-stent restenosis (DES-ISR) is not fully known. To further evaluate this impact, we aimed to describe the incidence of symptom-driven coronary angiography (SDCA), an under-reported but potentially informative outcome metric in this cohort of patients. Methods: We retrospectively identified all patients (n=28) who had DEB-treated DES-ISR at University Hospital Limerick in between 2013-2015 and evaluated the incidence of subsequent SDCA as the primary endpoint. Data were expressed as mean ± SD and %. Results: Baseline demographics demonstrate a mean age 63±9 years with 61% of DEB-treated DES-ISR presenting with acute coronary syndrome. Mean number of ISR per patient and number of DEB per lesion was 1.2±0.6 lesions and 1.2±0.6 balloons, respectively. The incidence of SDCA was 54% after mean follow-up duration of 179±241 days. 67.8% of patients had follow-up data beyond 12 months. Within the first year of follow-up, the incidence of SDCA with and without target lesion revascularization (TLR) was 11% and 36% respectively. Among patients with SDCA without TLR, 30% had an acute coronary syndrome not requiring percutaneous coronary intervention. Conclusions: A high incidence of SDCA was observed, particularly within the first 12 months after DEB-treated DES-ISR. This under-reported metric may represent a cohort at higher cardiovascular risk but requires further confirmation in larger studies.
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Ayman M Abu Mustafa
“Mobile apps and wearable technology are becoming ubiquitous in our environment. Their integration with healthcare delivery is just beginning to take shape. The early results are promising and the possibilities great."
BS, PharmD., MBA, CPHIMS, FHIMSS, Adjunct Professor, Global Healthcare Management, MCPHS University, Chief Strategy Offi cer, MedicaSoft, Senior Advisor, National Health IT (NHIT) Collaborative for Underserved, New York HIMSS, National Liaison, Health 2.0 Boston, Past Chair, Chair Innovation, USA
Helen Figge
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