Relation between E/e' ratio and NT-proBNP levels in elderly patients with symptomatic severe aortic stenosis

Background: Symptoms in the elderly patients with severe aortic stenosis (AS) and co-morbidities seem to lack in specificity. Therefore, objective parameters for increased left ventricular(LV) filling pressures are needed. The aim of this study was to investigate the correlation between the septal, lateral and average E/e' ratio and the value of the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP). Methods: Two-hundred-fifty consecutive symptomatic patients (mean age 80 ± 8 years, 52 % men) with severe AS underwent transthoracic echocardiography and NT-proBNP measurement. Results: In the overall population the septal E/e' (r = 0,459, r2 = 0,21, P 2 = 0,10, P 2 = 0,18, P 2 = 0,34, P 2 = 0,14, P 2 = 0,24, P <0,0001) were all significantly better correlated to NT-proBNP. In obese patients no significant correlations were seen. Previous bypass surgery did not alter the correlations. Conclusions: In elderly patients with severe symptomatic AS there is a significant correlation between the E/e' ratio and NT-proBNP, in particular after exclusion of confounders. The correlation was best for the septal E/e' ratio and was preserved in patients with a history of bypass surgery

Dual-Earner Family Policies at Work for Single-Parent Families

Family dynamics are changing and single-parent families are becoming more common across countries. In their flagship report “Progress of the World’s Women, 2019–2020,” UN Women (2019) demonstrated that, contrary to popular belief, couples with children do not constitute a majority of all families, but rather there are many different types of families. Single parenthood is considered a “new social risk” in poverty and inequality (Bonoli, 2013). Therefore, policy makers and legislators have designed targeted policy specifically for single parents, such as targeted child benefits to single parents. In addition, legislation and social policy have been designed and implemented specifically for single parents, such as child support and family law such as child custody and shared residence. This study takes a different approach, based on the universalist argument that without adequate social protection that benefits all families, those families that are more vulnerable are often hit the hardest. We focus on family policies, and specifically we examine whether and to what extent single parents benefit from the same family policies that are available to all families with children

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score &gt;5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

The third international symposium on tilapia in aquaculture

The study of constraints affecting the development of fish culture in rural Côte d'Ivoire has shown that it is impossible to use farming methods that require expensive inputs such as supplementary feed. In contrast, farmers are willing to devote much of their time to fish culture if their work is adequately compensated. When available, most inputs really accesible to farmers have a poor nutritional and/or fertilizing value. The efficient use of the limited trophic resources can be done through : (1) the qualitative trophic and/or quantitative improvement of the flow of substances in the different levels of the pond trophic web (direct feeding, autotrophic productivity and heterotrophic microbial productivity) and (2) improvement of the accessibility to trophic resources by the fish. The present study is based on on-farm and on-station experiments focusing on : (1) the improvement of culture environment (treatments based on use of rice bran to which green manure may or may not be added, and on combined fish and rabbit culture) and (2) the use of a substratum made of bamboo or branches (acadja) to improve fish accessibility to primary production (attempts to substitute commercial feed by acadja system in lagoon pens have already been giving promising results). The results from this study confirm the importance of adding substrate for primary producers, of combining fish and rabbit culture and of using green manure for the improvement of pond production. New approaches for research and R&D in low input fish culture are suggested. (Résumé d'auteur