The hidden hand of chloride in hypertension

Among the environmental factors that affect blood pressure, dietary sodium chloride has been studied the most, and there is general consensus that increased sodium chloride intake increases blood pressure. There is accruing evidence that chloride may have a role in blood pressure regulation which may perhaps be even more important than that of Na+. Though more than 85 % of Na+ is consumed as sodium chloride, there is evidence that Na+ and Cl− concentrations do not go necessarily hand in hand since they may originate from different sources. Hence, elucidating the role of Cl− as an independent player in blood pressure regulation will have clinical and public health implications in addition to advancing our understanding of electrolyte-mediated blood pressure regulation. In this review, we describe the evidence that support an independent role for Cl− on hypertension and cardiovascular health

Major Outcomes in Atrial Fibrillation Patients with One Risk Factor: Impact of Time in Therapeutic Range

BACKGROUND: The benefits and harms of oral anticoagulation (OAC) therapy in patients with only one stroke risk factor (i.e. CHA2DS2-VASc= 1 in males, or 2 in females) has been subject of debate. METHODS: We analysed all patients with only one stroke risk factor from the merged datasets of SPORTIF III and V trials. Anticoagulation control was defined according to time in therapeutic range (TTR). RESULTS: Of the original trial cohort, 1,097 patients had only one stroke risk factor. Stroke/systemic thromboembolic event had an incidence of 0.9 per 100 patient-years, with an incidence of 1.6 per 100 patient-years for all-cause death and 2.3%/patient-years for the composite outcome of stroke/systemic thromboembolic event/all-cause death. There were no significant differences in the risk for stroke/systemic thromboembolic event between sexes, nor between the different stroke risk factors amongst these atrial fibrillation patients with only one stroke risk factor. Cox regression analysis in patients treated with warfarin only found TTR to be inversely associated with stroke/systemic thromboembolic event (p=0.034) and all-cause death (p=0.015). Chronic heart failure was significantly associated with the outcome of all-cause death (p=0.0019) and the composite outcome of stroke/systemic thromboembolic event/all-cause death (p=0.021). There was a significant inverse linear association between TTR and the cumulative risk for both stroke/systemic thromboembolic event and all-cause death (both p<0.001). CONCLUSIONS: In atrial fibrillation patients with only one additional stroke risk factor (i.e. CHA2DS2-VASc= 1 in males or 2 in females), rates of major adverse events (stroke/systemic thromboembolic event, mortality) were high, despite anticoagulation. TTR in warfarin-treated patients was inversely associated with the occurrence of both stroke/systemic thromboembolic event and all-cause death

Do physicians correctly calculate thromboembolic risk scores?: a comparison of concordance between manual and computer‐based calculation of CHADS2 and CHA2DS2‐VASc scores

[Abstract] BACKGROUND: Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). AIM: The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. METHODS: We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores RESULTS: The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. CONCLUSION: We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score

Does measurement technique explain the mismatch between European head size and WHO charts?

Objective To test whether different measuring techniques produce systematic differences in head size that could explain the large head circumferences found in Northern European children compared with the WHO standard. Design: Cross-sectional observational study. Setting: Scotland, UK. Patients: Study 1: 68 healthy children aged 0.4–18 months from mother and baby groups and a medical students teaching session. Study 2: 81 children aged 0.4 to 25 months from hospital wards and neonatal follow-up clinics. Interventions: Study 1: heads measured with plastic tape using both the WHO tight and UK loose technique. Study 2: heads measured using WHO research technique and a metal measuring tape and compared with routinely acquired measurements. Main outcome measures: Mean difference in head z-scores using WHO standard between the two methods. Results: The tight technique resulted in a mean (95% CI) z-score difference of 0.41 (0.27 to 0.54, p&lt;0.001) in study 1 and 0.44 (0.36 to 0.53, p&lt;0.001) in study 2. However, the mean WHO measurements in the healthy infants still produced a mean z-score that was two-third of a centile space (0.54 SD (0.28 to 0.79) p&lt;0.001) above the 50th centile. Conclusion: The WHO measurement techniques produced significantly lower measures of head size, but average healthy Scottish children still had larger heads than the WHO standard using this method

The year in cardiology: arrhythmias and pacing.

During this last year, there has been much progress with regard to anticoagulant and ablation therapy for atrial fibrillation (AF). Apart from recently issued European Society of Cardiology Guidelines for the management of patients with supraventricular arrhythmias, there has been little progress in research in this field. Ventricular arrhythmias and device therapy have seen modest progress

Pembinaan konstruk instrumen penilaian pasca penghunian untuk perumahan bertingkat yang dibina menggunakan kaedah Sistem Binaan Berindustri (IBS)

Post Occupancy Evaluation (POE) is an activity of the building evaluation process with a focus on quality, operational performance and satisfaction of the occupants. The POE is important to evaluate completed and occupied buildings to identify weaknesses and potential for future improvement. To date, there have been various variations of POE instruments and tools to evaluate occupied buildings. However, the POE instrument for assessing high-rise housing constructed using the industrialized building system (IBS) method has not been developed specifically. In this regard, this study aims to discuss the construction of an effective POE instrument to measure the quality and performance of high-rise housing built using the IBS method. For this purpose, the 3 round Delphi method was adapted by involving 15 experts selected based on their background and experience related to IBS. The results of a three-round Delphi study found that 33 out of all sub-constructs were dropped because of low mean scores (<4.2 in two rounds) while 75 sub-constructs were identified as final items. The results of the Delphi study also found that all 10 constructs were 1) Spatial; 2) Design and aesthetics; 3) Physical; 4) Building materials; 5) Quality of work; 6) Comfort and well-being; 7) Environment and health; 8) Maintenance; 9) Value and 10) Cost is the most significant construct for developing PPP instruments. Accordingly, an effective Post-Occupancy Assessment Instrument for measuring the quality, performance and value of a home built using the IBS method should include all of these constructs

Squeeze flow and compaction behavior of toughened polyimide matrix composites

The main emphasis was placed upon the squeeze flow and compaction behavior of the Lewis Research Center (LaRC) research project series polyimide matrix composites. The measurement of squeeze film flow behavior was performed by a plastometer which monitors the change of thickness of a prepreg specimen laid between two parallel plates under the specified temperature and pressure history. A critical evaluation of the plastometer data was attempted by examining the morphology of the specimen at various points during the squeeze flow. The effects of crosslinks (Mc) of resin, imidization (B-ataging) condition, and pressure on the squeeze flow behavior were examined. Results are given

PENERAPAN MODEL PEMBELAJARAN REALISTIC MATHEMATICS EDUCATION (RME) UNTUK MENINGKATKAN KEBERANIAN DAN PRESTASI BELAJAR

The aims of this study are: (1) To describe the students' courage in the content of mathematics lessons through the application of RME. (2) To describe student learning achievement on the content of mathematics lessons through the application of the RME learning model. (3) To describe the effectiveness of the application of the RME learning model in increasing students' courage and achievement in mathematics lessons in class VI SDN 03 Mukomuko City District. In this study, the Classroom Action Research Model (CAR) was used and continued with Quasi Experimental research. The subjects of this study were students of class VI SDN 03 Mukomuko City District. With class VIc as the CAR class, class VIb as the experimental class, and class VIa as the control class. Data collection techniques used in the study were observation sheets and student test models. Analysis of the data used values are (1) Analysis of Student Courage (2) Analysis of Pre-test and Post-Test, (3) Analysis of Student Achievement Test. Instrument validation and student courage. The conclusions of this research are; (1) The application of the RME learning model can increase students' courage. (2) The application of the RME learning model can improve student achievement in Mathematics in Class VI SDN 03 Mukomuko City in the 2022/2023 academic year and (3) The application of the RME learning model in improving student achievement compared to learning models that do not use the RME mode

Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry

Introduction Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple strategy of integrated approach of AF management: A—Avoid stroke; B—Better symptom control; C—Cardiovascular comorbidity risk management. Aims Evaluation of the AF treatment compliance to ABC pathway in DM patients in the Middle East. Assessment of the impact of ABC pathway adherence on all‐cause mortality and the composite outcome of stroke/systemic embolism, all‐cause death and cardiovascular hospitalisations. Methods From 2043 patients in the Gulf SAFE registry, 603 patients (mean age 63; 48% male) with DM were included in an analysis of ABC pathway compliance: A—appropriate use of anticoagulation according to CHA2DS2‐VASc score; B—AF symptoms management according to the European Heart Rhythm Association (EHRA) scale; C—Optimised cardiovascular comorbidities management. Results 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1‐year follow‐up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC group vs non‐ABC (5.8% vs 15.9%, P = .0014, respectively). On multivariate analysis, ABC compliance was associated with a lower risk of all‐cause death and the composite outcome after 6 months (OR 0.18; 95% CI: 0.42‐0.75 and OR 0.54; 95% Cl: 0.30‐1.00, respectively) and at 1 year (OR 0.30; 95% Cl: 0.11‐0.76 and OR 0.57; 95% Cl: 0.33‐0.97, respectively) vs the non‐ABC group. Conclusions Compliance with the ABC pathway care was independently associated with the reduced risk of all‐cause death and the composite outcome in DM patients with AF, highlighting the importance of an integrated approach to AF management