Non-linear Methods in HRV Analysis

AbstractHeart rate variability (HRV) analysis has become an important tool in cardiology, these noninvasive measurements are relatively easy to perform, have good reproducibility and also provide prognostic information on patients with cardiac diseases. There are various methods in use to analyze the HRV; these methods usually can help in the early detection of some cardiac diseases. HRV analysis (meaning the study of hearts inter-beat time intervals) is useful for understanding the status of the Autonomic Nervous System (ANS). HRV reflects the cardiac system's ability to adapt to the changing external or internal circumstances by detecting and fast responding to the unexpected and unpredictable stimuli. HRV analysis has the ability to assess overall cardiac health and the state of the ANS responsible for regulating cardiac activity. This paper presents a detrended fluctuation analysis of RR time intervals and of their discrete wavelet transforms, comparing longer and shorter time series in order to find long term significant variations in the studied signals. Signals are taken from MIT-BIH Long Term ECG database, the analysis is performed under MATLAB environment

Vércukorcsökkentő gyógyszerek biztonságossága szívelégtelenségben | The safety of anti-diabetic drugs in heart failure

Absztrakt: A diabetes és szívelégtelenség társulása igen gyakori, ugyanakkor a két kórkép patofiziológiája és kórlefolyása is számos ponton találkozik. Napjainkban a rendelkezésre álló antidiabetikus gyógyszerek spektruma rendkívül széles, a klasszikus szerektől (inzulin, biguanidok, szulfanilureák) a legmodernebbekig (gliptinek, gliflozinok) terjed. Ezeknek a gyógyszereknek a cardiovascularis hatásai sokrétűek, ismeretük fontos a mindennapi gyakorlatban, ugyanis előnyben részesül a szívelégtelenség szempontjából biztonságos szerek alkalmazása. Munkánk áttekintést nyújt az egyes gyógyszercsoportokról – a hatásmechanizmus, valamint a főbb képviselők bemutatása után ismertetjük a cardiovascularis rendszerre és ezen belül a szívelégtelenségre gyakorolt hatásokat, megemlítve a fontosabb klinikai vizsgálatok eredményeit is. Az adatok egyértelműen alátámasztják a metformin és a gliflozinok kedvező és a thiazolidindionok káros hatását szívelégtelenségben. A többi gyógyszercsoport alkalmazása megengedett szívelégtelenség esetén, de fontos a dekompenzáció jeleinek folyamatos monitorozása. Orv. Hetil., 2017, 158(5), 163–171. | Abstract: The association of diabetes and heart failure is very common, furthermore, the pathophysiology and clinical course of the two entities have many crossing-points. Today, the spectrum of available anti-diabetic drugs is extremely wide, ranging from the classical (insulin, biguanides, sulphonylureas) to the most recent agents (gliptins, gliflozins). The cardiovascular effects of these drugs are multiple, their knowledge is important in the everyday practice, as the use of safe drugs regarding of heart failure is preferred. Our work provides an overview of each class of drugs after the presentation of the mechanism of action and the main representatives, the effects on the cardiovascular system, including those on heart failure will be described, mentioning the results of the most important clinical trials. The available data confirm the beneficial effects of metformin and gliflozins and the harmful effect of thiazolidinediones in heart failure. The other classes of drugs are permitted in heart failure, but it is important to continuously monitor the signs of decompensation. Orv. Hetil., 2017. 158(5), 163–171

Screening for Cognitive Dysfunction Helped to Unmask Silent Cerebrovascular Disease in a Hypertensive Diabetic Patient — Case Report

The current guidelines for the diagnosis and treatment of hypertension recommend screening for cognitive impairment in all hypertensive patients as part of the clinical assessment. However, the implementation of this recommendation in clinical practice is still unsatisfactory. We present the case of an elderly hypertensive female patient in order to highlight the importance of screening for cognitive impairment. A patient with a history of poorly controlled hypertension for the last 12 years and recently diagnosed with type 2 diabetes mellitus is admitted complaining of asthenia, dizziness, visual acuity impairment, and difficulty to remember recent information. Cardiovascular imaging showed 70% internal carotid artery stenosis in a neurologically asymptomatic patient. Cognitive testing showed mild cognitive impairment. Retinal imaging identified stage III hypertensive retinopathy accompanied by irreversible end-organ damage due to microvascular changes. At this point brain MRI was performed, which identified both macro- and microvascular brain lesions in the periventricular white matter and sequelae of a former ischemic stroke in the territory of the left posterior cerebral artery. Cognitive testing helped to unmask silent cerebrovascular disease in an otherwise oligosymptomatic hypertensive diabetic patient. Cognitive function testing should be introduced in routine clinical practice in order to help unmask silent cerebrovascular disease

Silent Ischemic Stroke Was Revealed after Screening for Cognitive Dysfunction in a Hypertensive Patient with New Onset Atrial Fibrillation – Case Report

Introduction: Hypertension is one of the most important modifiable risk factor related to cognitive decline and dementia. However, screening for cognitive dysfunction is not part of the routine clinical assessment

MANAGEMENTUL PARACLINIC PRIVIND STATUSUL METABOLIC LA PACIENȚII DIAGNOSTICAȚI CU DIABET ZAHARAT DE TIP 1 ȘI 2TIP 2

Inflammatory processes, mineral imbalances and appearance of certain pathological compounds in urine are common phenomena in diabetes mellitus. We studied two groups of diabetic patients (inpatients and ambulatory specialty outpatients) during the first six months of 2017. Laboratory parameters concerning inflammation, mineral balance and urine analysis were evaluated, respectively we analyzed the scheme of treatment in case of inpatients. Based on our results we can affirm that in 25.51% of the studied diabetics the presence of an inflammatory process could be found. In 26.53% mineral imbalances could be observed, and in 69.69% we detected the presence of certain pathological compounds in urine, most often glycosuria. Significantly higher incidence of pathological compounds in urine could be observed in inpatients compared to outpatients. The vast majority of inpatients were treated with insuline (88.65%), oral antidiabetic therapy, especially metformin, being predominant in outpatients. In conclusion, we can state that in only 29.08% of the studied diabetic patients the laboratory analyses show lack of any inflammatory process, absence of glycosuria, respectively scarceness of mineral imbalance. Keywords: diabetes mellitus, glucose, neuropathy, hyperglycaemia Procesul inflamator, dezechilibrele minerale și apariția unor compuși patologici în urină sunt fenomene des întâlnite în diabetul zaharat. Am studiat două loturi de pacienți diabetici (internați și din ambulatoriuL de specialitate) în primele șase luni ale anului 2017. Am evaluat parametrii de laborator referitor la inflamație, la echilibrul mineral și sumarul de urină, respectiv în cazul celor spitalizați am analizat și schema de tratament a pacienților. Pe baza rezultatelor obținute putem afirma că la 25,51 % dintre diabeticii studiați s-a putut constata prezența unui proces inflamator. La 26,53% s-au putut observa dezechilibre minerale, iar la 69,69% am constatat prezența unor compuși patologici în urină, cel mai des glucozuria. S-a putut observa incidența semnificativ mai mare a glucozuriei la pacienții internați față de cei din ambulatoriu. Marea majoritate a pacienților spitalizați au fost tratați cu insulină (88,65%), terapia cu antidiabetice orale predominând la subiecții din ambulatoriu, mai ales preparatele conținând metformin. În concluzie, putem afirma că doar la un procentaj de 29,08% dintre pacienții diabetici studiați analizele de laborator arată lipsa unui proces inflamator, absența glucozuriei și cetonuriei, respectiv lipsa unui dezechilibru mineral. Cuvinte cheie: diabet zaharat, glucozurie, neuropatie, hiperglicemi

Total 25-Hydroxyvitamin D Is an Independent Marker of Left Ventricular Ejection Fraction in Heart Failure with Reduced and Mildly Reduced Ejection Fraction

Vitamin D emerged as an important prognostic biomarker in heart failure (HF), with currently highly debated therapeutic implications. Several trials on vitamin D supplementation in HF showed improvements in left ventricular (LV) remodeling and function and health-related quality of life (HRQoL), which did not translate into mid- to long-term beneficial effects regarding physical performance and mortality. We addressed total 25-hydroxyvitamin D (25(OH)D), serum albumin, and uric acid (UA) levels, focusing mainly on vitamin D deficiency, as potential markers of LV systolic dysfunction in HF with reduced and mildly reduced ejection fraction (HFrEF, HFmrEF). Seventy patients with LVEF p = 0.008, p = 0.009, and p = 0.001). Serum UA (7.4 ± 2.4 vs. 5.7 ± 2.1, p = 0.005), NT-proBNP levels (1090.4 (675.2–2664.9) vs. 759.0 (260.3–1474.8), p = 0.034), and MLHFQ scores (21.0 (14.0–47.0) vs. 14.5 (4.5–25.5), p = 0.012) were significantly higher, whereas 25(OH)D concentrations (17.6 (15.1–28.2) vs. 22.7 (19.5–33.8), p = 0.010) were lower in subjects with severely reduced LVEF. Also, 25(OH)D was independently associated with LVEF in univariate and multiple regression analysis, maintaining its significance even after adjusting for confounders such as age, NT-proBNP, the presence of chronic coronary syndrome, hypertension, and anemia. According to our current findings, 25(OH)D is closely associated with LVEF, further supporting the need to establish correct vitamin D supplementation schemes and dietary interventions in HF. The changes in LVEF, 25(OH)D, serum UA, and albumin levels in HFrEF and HFmrEF indicate a similar pathophysiological background

Dental Students’ Tobacco Smoking Habits, Second-hand Smoke Exposure, and Training in Cessation Counselling at the University of Medicine Pharmacy Sciences and Technology of Târgu Mureș

Objectives: To describe tobacco smoking habits, attitudes, second-hand smoke exposure, and training in cessation counselling at the University of Medicine Pharmacy, Sciences and Technology of Târgu-Mureș (UMPSTTM), as baseline data for the first Romanian university to implement a Smoke Free University Project

Relationship between Nutrition, Lifestyle Habits and Laboratory Parameters in Hypertensive Patients with/without Cognitive Dysfunction

(1) Background: Cognitive dysfunction is a major concern in hypertensive patients. Lifestyle habits and nutrition influence laboratory parameters, with an impact on clinical course. The objective of the study was to evaluate nutrition and lifestyle habits in hypertensive patients with/without cognitive dysfunction and establish correlations to laboratory parameters. Material and Methods: 50 patients admitted to the Cardiovascular Rehabilitation Clinic in Târgu Mureș were enrolled in this study between March–June 2021. We evaluated their cognitive function, and they filled in a questionnaire about lifestyle and nutrition. Biochemical blood tests were performed using a Konelab Prime 60i analyzer. IBM-SPSS22 and GraphPad InStat3 were used for statistics. Results: Mean age of hypertensive patients (n = 50) was 70.42 ± 4.82 (SD) years, half of them had cognitive dysfunction. Zinc deficiency was present in 74% of the subjects. The subgroup with cognitive dysfunction had significantly higher BMI (p = 0.009) and microalbuminuria (p = 0.0479), as well as significantly lower magnesium intake (p = 0.032) and cholesterol intake (p = 0.022), compared to those with normal cognitive status. Conclusions: Nutrition is in a close relationship with laboratory parameters; significant differences (microalbuminuria, cholesterol intake, BMI, etc.) are present between hypertensive patients with/without cognitive dysfunction. A healthy diet is important for the maintenance of metabolic balance, the achievement of optimal body weight, and the prevention of complications