The use of anticoagulants in morbidly obese patients

Due to its constantly growing incidence, obesity is an increasingly serious social and medical problem. Available data on the use of novel oral anticoagulants in morbidly obese and obese patients are very limited. However, we tried to summarize the available knowledge on the use of anticoagulants in this subpopulation of patients in everyday clinical practice. Studies on the clinical use of anticoagulants provide a poor basis for any adjustment of doses in obese patients as compared to patients with normal body weight. In our opinion, further studies are required in this particular population

The use of anticoagulants in chronic kidney disease: Common point of view of cardiologists and nephrologists

In patients diagnosed with chronic kidney disease (CKD), atrial fibrillation (AF) is associated withan increased risk of thromboembolism and stroke. Moreover, patients with CKD — especially those inend-stage renal disease — also present an increased risk of bleeding. Oral anticoagulation is the mosteffective form of thromboprophylaxis in patients with AF and an increased risk of stroke. However, theunderuse of these drugs was observed, mainly due to safety reasons and restricted evidence on efficacy.Much evidence suggests that non-vitamin K-dependent oral anticoagulant agents significantly reducethe risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding ratescompared with vitamin K antagonists, such as warfarin, in normal renal function subjects. Thus, theyare currently recommended for that group of patients. However, their metabolism is largely dependenton the kidneys for elimination, and current knowledge in this area is limited due to patients witha decreased glomerular filtration rate are usually excluded from clinical trials. The present review articlefocuses on currently available data on oral anticoagulants in patients with moderate to advancedchronic kidney disease and those with end stage renal disease

Impact of obesity on electrocardiographic abnormalities, cardiac arrhythmias and autonomic nervous system dysfunction

Otyłość jest jedną z epidemii naszych czasów i często współistnieją z nią: nadciśnienie tętnicze, hiperlipidemia, cukrzyca oraz obturacyjny bezdech podczas snu. Udowodniono, że otyłość jest niezależnym czynnikiem ryzyka powikłań sercowo-naczyniowych, w tym także zgonu. Obserwowana w grupie otyłych chorych zwiększona liczba zgonów z przyczyn sercowo-naczyniowych wynika głównie ze współistnienia licznych czynników ryzyka miażdżycy. Na podstawie badań eksperymentalnych i klinicznych wykazano, że otyłości towarzyszy aktywacja autonomicznego układu współczulnego oraz upośledzenie funkcji autonomicznego układu przywspółczulnego, a brak równowagi między tymi składowymi w obrębie serca może być przyczyną zagrażających życiu arytmii. U osób z otyłością olbrzymią w standardowym elektrokardiogramie często obserwuje się liczne nieprawidłowości. Do najczęściej opisywanych odchyleń w tym badaniu należą: odchylenie w lewo osi załamków P i zespołów QRS, zmniejszenie amplitudy zespołów QRS w odprowadzeniach przedsercowych oraz zaburzenia repolaryzacji (zmiany załamków T, wydłużenie odstępu QT/QTc). Uzupełnienie diagnostyki o 24-godzinne monitorowanie EKG metodą Holtera nierzadko pozwala ujawnić potencjalnie groźne arytmie — oprócz częstej ekstrasytolii nad- i komorowej obserwuje się niekiedy napady migotania przedsionków i inne tachyarytmie. Kolejny element diagnostyki holterowskiej — badanie zmienności i turbulencji rytmu serca — pozwala ocenić funkcje układu autonomicznego i oszacować ryzyko zgonu z przyczyn sercowo-naczyniowych. Terapia otyłości wpływa na regresję odchyleń elektrokardiograficznych, co jest wyrazem korzystnych zmian strukturalnych oraz poprawy funkcji układu autonomicznego serca i przekłada się na zmniejszenie zagrożenia groźnymi arytmiami oraz nagłym zgonem sercowym.Obesity is considered global epidemic and it is often accompanied by other diseases such as arterial hypertension, hyperlipidemia, type 2 diabetes mellitus and obstructive sleep apnoea. It has been proved that obesity is an independent risk factor for cardiovascular diseases and cardiovascular mortality. The increase in mortality rate in obese patients is due to combination of multiple atherosclerotic risk factors. Experimental and clinical trials revealed that obesity is associated with hyperactivity of the sympathetic nervous system (SNS) and depression of parasympathetic tone. The autonomic imbalance may contribute to the develop ­ment of life-threatening arrhythmias. The standard electrocardiogram in obese patients shows numerous abnormalities. The most common are: leftward shift of the P, QRS, and T axes, low QRS voltage in precordial leads, repolarization abnormalities, prolonged QT interval and prolonged corrected QT interval. 24-hour ECG monitoring may demonstrate potentially dangerous arrhythmias — aside from supraventricular and ventricular premature beats, paroxysmal atrial fibrillation and other tachyarrhythmias may be observed. The analysis of heart rate variability and heart rate turbulence can be considered another tool in the evaluation of cardiovascular mortality risk. Obesity treatment and substantial weight loss reverses many ECG alterations, which are related to regression of structural changes in the heart and improvement in autonomic function. Thus it may have favorable effect in reduction of life-threatening arrhythmias and sudden cardiac death

Reshaping medical education: Performance of ChatGPT on a PES medical examination

Background: We are currently experiencing a third digital revolution driven by artificial intelligence (AI), and the emergence of new chat generative pre-trained transformer (ChatGPT) represents a significant technological advancement with profound implications for global society, especially in the field of education. Methods: The aim of this study was to see how well ChatGPT performed on medical school exams and to highlight how it might change medical education and practice. Recently, OpenAI’s ChatGPT (OpenAI, San Francisco; GPT-4 May 24 Version) was put to the test against a significant Polish medical specialization licensing exam (PES), and the results are in. The version of ChatGPT-4 used in this study was the most up-to-date model at the time of publication (GPT-4). ChatGPT answered questions from June 28, 2023, to June 30, 2023. Results: ChatGPT demonstrates notable advancements in natural language processing models on the tasks of medical question answering. In June 2023, the performance of ChatGPT was assessed based on its ability to answer a set of 120 questions, where it achieved a correct response rate of 67.1%, accurately responding to 80 questions. Conclusions: ChatGPT may be used as an assistance tool in medical education. While ChatGPT can serve as a valuable tool in medical education, it cannot fully replace human expertise and knowledge due to its inherent limitations

Beyond ChatGPT: What does GPT-4 add to healthcare? The dawn of a new era

Over the past few years, artificial intelligence (AI) has significantly improved healthcare. Once the stuffof science fiction, AI is now widely used, even in our daily lives — often without us thinking about it.All healthcare professionals — especially executives and medical doctors — need to understand the capabilitiesof advanced AI tools and other breakthrough innovations. This understanding will allow themto recognize opportunities and threats emerging technologies can bring to their organizations. We hope tocontribute to a meaningful public discussion about the role of this new type of AI and how our approachto healthcare and medicine can best evolve with the rapid development of this technology.Since medicine learns by example, only a few possible uses of AI in medicine are provided, which merelyoutline the system’s capabilities.Among the examples, it is worth highlighting the roles of AI in medical notes, education, preventiveprograms, consultation, triage and intervention.It is believed by the authors that large language models such as chat generative pre-trained transformer(ChatGPT) are reaching a level of maturity that will soon impact clinical medicine as a whole andimprove the delivery of individualized, compassionate, and scalable healthcare. It is unlikely that AIwill replace physicians in the near future. The human aspects of care, including empathy, compassion,critical thinking, and complex decision-making, are invaluable in providing holistic patient care beyonddiagnosis and treatment decisions. The GPT-4 has many limitations and cannot replace direct contactbetween an experienced physician and a patient for even the most seemingly simple consultations, not tomention the ethical and legal aspects of responsibility for diagnosis

Improvement of left ventricular diastolic function and left heart morphology in young women with morbid obesity six months after bariatric surgery

   Background: Obesity contributes to left ventricular (LV) diastolic dysfunction (LVDD) and may lead to diastolic heart failure. Weight loss (WL) after bariatric surgery (BS) may influence LV morphology and function. Using echocardiography, this study assessed the effect of WL on LV diastolic function (LVDF) and LV and left atrium (LA) morphology 6 months after BS in young women with morbid obesity. Methods: Echocardiography was performed in 60 women with body mass index ≥ 40 kg/m², aged 37.1 ± ± 9.6 years prior to and 6 months after BS. In 38 patients, well-controlled arterial hypertension was present. Heart failure, coronary artery disease, atrial fibrillation and mitral stenosis were exclusion criteria. Parameters of LV and LA morphology were obtained. To evaluate LVDF, mitral peak early (E) and atrial (A) velocities, E-deceleration time (DcT), pulmonary vein S, D and A reversal velocities were measured. Peak early diastolic mitral annular velocities (E’) and E/E’ were assessed. Results: Mean WL post BS was 35.7 kg (27%). A postoperative decrease in LV wall thickness, LV mass (mean 183.7 to 171.5 g, p = 0.001) and LA parameters (area, volume) were observed. LVDD was diagnosed in 3 patients prior to and in 2 of them subsequent to the procedure. An improvement in LVDF Doppler indices were noted: increased E/A, D and E’ lateral, and decreased S/D and lateral E/E’. None of the patients showed increased LV filling pressure. No significant correlations between hypertension and echo-parameters were demonstrated. Conclusions: Six months after BS weight loss resulted in the improvement of LVDF and left heart morphology in morbidly obese women. (Cardiol J 2018; 25, 1: 97–105