UNDERSTANDING DYSPEPSIA IN PATIENTS WITH PARKINSON’S DISEASE

Objectives: Better understanding dyspepsia in Parkinson’s disease (PD) in order to improve patients quality of life.Methods: 27 patients (17 men,10 women, mean age=68,11± 12,62 years) diagnosed with PD (Hoehn-Yars scale), treated with levodopa or dopamine agonists, with gastrointestinal autonomic disorders and disturbances of gastric motility assessed by ultrasound approach undertook a trial consisting of a treatment with Trimebutine 300 mg/day for 3 months. We have assessed digestive severity symptoms scores before and after therapy: no symptoms=0, mild=1, medium=2, severe=3, comparing also to gastric motility curves.Results: Before therapy 15 patients showed delayed of the gastric emptying (55,56%), 7 normal motility (25,92%) and 5 patients rapid emptying (18,51%).Symptoms severity scores before therapy were: 8 patients (29,52%) mild ,14 patients (51,85%) medium and 5 patients (18,51%).severe. Mean dyspepsia severity index in patients with gastric motility disorders before therapy was 2,20±0,52.After therapy the same index decreased to 1,50±0,69(p=0,0009).Gastric motility curves showed an improving after therapy more important in those with delaying emptying varying with 23,45%±14,03 versus 15%±5,87% in patients with rapid emptying (either p<0,001).Conclusions An important range of patients with PD, with nausea and vomiting presented gastric motility disorders (74,07%), most of them having delay of the emptying and a satisfactory response to the treatment with Trimebutine with improving of symptom severity index and also gastric motility

Nonalcoholic Fatty Liver Disease, Procalcitonin, and Gut Microbiota: Players in the Same Team

The study aimed to assess the link between procalcitonin (PCT) and gut dysbiosis in patients with nonalcoholic fatty liver disease (NAFLD). A total of 125 research participants, 100 patients with NAFLD (59% women and 41% men) age between 43 and 84 years and 25 healthy controls, joined this observational study. Patients were consecutively enrolled into two groups: 50 with gut dysbiosis and 50 without gut dysbiosis, after several conditions have been ruled out. Patients from dysbiotic group displayed significantly lesser use of biguanides and statins and elevation of fatty liver index (FLI), PCT, C-reactive protein (CRP), and alanine aminotransferase (ALT). Their gut microbiome was characterized by Bacteroides and Prevotella sp. dominant enterotype (74%) and by Ruminococcus sp. in only 26% of cases. The decrease of H index of biodiversity was observed in 64% of patients as well as of Firmicutes/Bacteroidetes (F/B) ratio and Akkermansia muciniphila in 60%. The increase of lipopolysaccharide positive bacteria was noted in 62% of patients. PCT strongly correlated with the level of CRP and ALT as well as to stool’s H index of biodiversity and F/B ratio. Dysbiotic patients with NAFLD exhibited significant elevation of PCT that correlated well with the H index of stool’s microbiota biodiversity, F/B ratio, CRP level, and severity of cytolytic syndrome

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

The Impact of Hypertension and Atrial Fibrillation on Cognitive Decline and Subclinical Atherosclerosis

Background: Assessment of cognitive impairment and the presence of subclinical atherosclerosis are very important especially in patients with cardiovascular risk factors. Methods: We included 155 hypertensive patients (84 with AF versus 71 without AF) to identify the premature cognitive impairment, the earliest signs of subclinical atherosclerosis and onset of myocardial dysfunction and to evaluate the type of anticoagulation used, the importance of CHA₂DS₂-VASc score (</>3), age (</>65 years) in hypertensive patients with AF. Results: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), Left Ventricular Ejection Fraction (LVEF) were significantly decreased, and Activities of Daily Living Score (ADL), Geriatric Depression Scale(GDS-15), and intima–media thickness (IMT) were significantly increased in hypertensive patients with AF vs. without AF (p < 0.05). MMSE was significantly decreased, ADL and IMT were significant increased in patients with AF and CHA₂DS₂-VASc>3 and non-vitamin K antagonists oral anticoagulants therapy (NOACs)(p < 0.05). Patients with age >65 with AF had higher rates of cognitive impairment (MMSE significant decrease) and a larger IMT (significant increase) versus patients with AF and age <65 (p < 0.05). Conclusions: Cognitive impairment is encountered in hypertensive patients having AF. Our conclusions suggest a direct link between cognitive impairment, depression, hypertension, AF, age, CHA₂DS₂-VASc score, type of anticoagulants used, LVEF, cognitive parameters, and IMT. We acknowledge the importance of identifying and preventing cognitive changes

Correlation between sleep apnea syndrome and heart failure depending on ejection fraction

OBJECTIVES The aim of this study was to analyze the correlations between sleep apnea syndrome(SAS) and heart failure(HF) in patients with preserved or reduced ejection fraction(EF). MATERIALS AND METHODS We evaluated 51 patients with suspected SAS and HF in sleep lab in Timișoara. General data was collected using sleep questionnaires, anthropometric measurements, somnography for apnea-hypopnea index, oxygen desaturation index, echocardiographic data, comorbidities and lab tests. RESULTS Creatinine -1.1±0.2 vs 1.4±0.7, p=0.05; stroke-23% vs 4%, p=0.04; aortic insufficiency-11.5% vs 36%, p=0.04; tricuspid insufficiency-46.1% vs 80%, p=0.01. Differences between groups regarding anthropometric measurements, somnographic index, lipidic profile were not statistically significant.. CONCLUSIONS Patients with SAS-IC with preserved EF have a higher risk of stroke events. Patients with IC with EF<50% had a significantly increased risk of developing a life-long chronic kidney disease. The SAS-IC population with low EF is at a higher risk of developing aortic and tricuspid insufficiency. REFERENCES 1. Douglas T. Sleep Apnea and Heart Failure. Part1: Obstructive Sleep Apnea. Circulation.2003.107:1671-1678. 2. Takatoshi K, Douglas TB. Obstructive Sleep Apnea and Heart Failure-Pathophysiologic and Therapeutic Implication. Journal of the American College of Cardiology. 2011; 57:doi: 10.1016/j.jacc.2010.08.627 3. Ferrier K, Campbell A, Yee B et al. Sleepdisordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest. 2005;128:2116–2122

ARTYKUŁ ORYGINALNYZwiązek pomiędzy elektrofizjologicznymi i echokardiograficznymi parametrami sprzyjającymi migotaniu przedsionków u chorych bez organicznej choroby serca

Background: The electroanatomical substrate of dilated atria is characterised by increased non-uniform anisotropy and macroscopic slowing of conduction, which promote reentrant circuits. Aim: To analyse the relationship between electrophysiological properties of atria and echocardiographic markers of dilatation and increased filling pressure. Methods: The study group consisted of 79 patients without structural heart disease, aged 53&#177;22 years, who were referred for electrophysiological study. In order to examine the atrial electrophysiological characteristics we studied interatrial conduction time (iaCT), double potentials and fragmented atrial activity during premature stimulation of the high right atrium (HRA). The analysed parameters included: duration of atrial activity, baseline iaCT (iaCTb) between HRA and distal coronary sinus (CS), iaCT during HRA pacing S1S1 600 ms (iaCTS1), maximum prolongation of iaCT during S2 and S3 delivery (iaCTS2, iaCTS3). We also calculated the decremental index (DI)=iaCT S3- iaCTS1/iaCTS1%. The following echocardiographic parameters were assessed: left atrial (LA) dimensions, surface (LAs), volume using ellipse formula (LAv), right surface (RAs), total atrial surface (TAs=LAs+RAs), and global myocardial index (GMI). Results: Patients were divided into two groups. Group 1 consisted of 37 patients with evidence of slow atrial conduction (atrial fragmentation/iaCTb>80ms/DI>50%/double atrial potentials), whereas group 2 was composed of 42 patients without slow conduction properties. There were no significant differences concerning age, body mass index or LA parasternal dimensions between the groups. Thirty-seven patients, of whom 32 were from group 1, had documented episodes of paroxysmal atrial fibrillation. GMI, LAs, LAv and TAs values were significantly higher in patients from group 1 than in group 2 subjects. A statistically significant linear correlation between iaCTb and TAs (r=0.52 pWstęp: Elektroanatomiczne parametry sprzyjające występowaniu migotania przedsionków (AF) u chorych z powiększonym lewym przedsionkiem (LA) polegają na anizotropii i zwolnieniu przewodzenia, co stanowi podłoże nawrotnych arytmii. Cel: Zbadanie związku pomiędzy elektrofizjologicznymi właściwościami przedsionków a powiększeniem przedsionka i zwiększonym ciśnieniem napełniania. Metodyka: Grupę badaną stanowiło 79 chorych bez organicznej choroby serca w średnim wieku 53&#177;22 lata, którzy zostali zakwalifikowani do wykonania inwazyjnego badania elektrofizjologicznego. Podczas stymulacji programowanej prawego przedsionka (HRA) oceniano takie parametry elektrofizjologiczne jak czas przewodzenia międzyprzedsionkowego (iaCT) i występowanie podwójnych potencjałów oraz fragmentację potencjałów przedsionkowych. W szczególności oceniano czas pobudzenia przedsionków, podstawowy iaCT (iaCTb) pomiędzy HRA a dystalnym odcinkiem zatoki wieńcowej (CS), iaCT podczas stymulacji HRA o długości cyklu S1-S1 600 ms (iaCTS1) i maksymalne wydłużenie iaCT po bodźcach przedwczesnych S2 i S3 (iaCTS2, iaCTS3). Obliczono także indeks zwolnienia przewodzenia (ang. decremental index) (DI)=iaCTS3-iaCTS1/iaCTS1%. Parametry hemodynamiczne, oceniane przy pomocy echokardiografii, obejmowały ocenę wielkości LA, powierzchni LA (LAs), objętości LA przy użyciu wzoru elipsowego (LAv), powierzchni RA (RAs), całkowitej powierzchni przedsionków (TAs=LAs+RAs) oraz globalnego indeksu sercowego (GMI). Wyniki: Chorych podzielono na dwie grupy w zależności od zmierzonych parametrów elektrofizjologicznych. Grupę 1 stanowiło 37 chorych ze zwolnionym przewodzeniem (fragmentacja potencjałów przedsionkowych, iaCTb >80 ms, DI >50% lub obecność podwójnych potencjałów), podczas, gdy grupę 2 stanowiło 42 chorych bez zaburzeń przewodzenia w przedsionkach. Obie grupy nie różniły się istotnie pod względem wieku, indeksu masy ciała lub wymiarami LA. U 37 chorych (w tym 32 pacjentów z grupy 1) występowały w przeszłości udokumentowane napady AF. Wartości GMI, LAs, LAv i TAs były istotnie większe w grupie 1 niż w grupie 2. Wykazano istotną liniową korelację pomiędzy iaCTb i TAs (r=0.52,

Josephine Peary reclining by window

Photograph of Josephine Peary reclining by a window, with many cushions and furs, including large polar bear fur on the floor.https://dune.une.edu/jpeary_images/1001/thumbnail.jp

MONOAMINE OXIDASE INHIBITION IMPROVES VASCULAR FUNCTION IN MAMMARY ARTERIES FROM NON-DIABETIC AND DIABETIC PATIENTS WITH CORONARY HEART DISEASE

Monoamine oxidases (MAOs) are mitochondrial enzymes with 2 isoforms that have emerged as important contributors to cardiovascular oxidative stress via the constant generation of hydrogen peroxide. The present study was purported to assess whether MAO-derived H2O2 contributes to the endothelial dysfunction in mammary arteries harvested from coronary heart disease patients with/without diabetes mellitus subjected to coronary artery bypass grafting. To this aim the effects of MAO inhibition on vascular contractility to phenylephrine and endothelial-dependent relaxation (EDR) in response to acetylcholine were studied in vascular segments. Clorgyline (irreversible MAO A inhibitor), selegiline (irreversible MAO B inhibitor), and moclobemide (reversible MAO A inhibitor) were applied in the organ bath (10Âľmol/L). MAO expression was assessed by immunohistochemistry. We found a constant impairment of EDR that has been significantly attenuated in the presence of the MAO A and B inhibitors in both groups of coronary heart disease patients. MAO B was the dominant isoform in all human diseased vessels. In conclusion, in vitro inhibition of MAO significantly improved endothelium-dependent relaxation in human mammary arteries, regardless the presence of diabetes. These data suggest that MAO inhibitors might be useful in restoring endothelial response in clinical conditions associated with increased oxidative stress, such as coronary artery disease and diabetes.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients

Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients