The Impact of Nursing Care in the Intensive Care Unit

As the population ages, the number of patients with more than one chronic disease increases, leading to a greater need for medical care. As a result, the demand for emergency and intensive care in recent years has become increasingly critical. It is advanced practice nurses who play a key role in patient care, and the drive to strengthen the workforce necessitates an increase in their involvement. The independence of advanced practice nurses and their impact on patient outcomes after critical care are of interest. The important role of nurses in the provision of health care has recently been recognized. Critical care needs inter-professional teams that provide collaborative health care, which includes the need for trained nurses. Expert and specialized care for the most seriously ill or injured patients in intensive care units (ICUs) and hospitals is provided by intensive care nurses. Working as part of a multidisciplinary team, they are experienced professionals who are highly skilled and safety-critical. The greatest responsibility for the care and treatment of patients in a critical or unstable clinical situation in the intensive care unit rests with the nurse. Her primary activities are the management and coordination of nursing care through assessments, therapies, and critical interventions. Based on the best available scientific evidence, clinical experience, and patient preferences, the nurse makes important clinical decisions in the intensive care unit

Tumor Necrosis Factor - alpha in Clinical Manifestation of Paroxysmal Atrial Fibrillation

Въведение: Предсърдното мъждене (ПМ) е най-честата аритмия в клиничната практика. Все повече данни се натрупват за участието на цитокините в патогенезата на аритмията, като обект на изследване до момента са преди персистиращата и перманентната форма на ритъмното нарушение.Цел: Да се потърсят промени в плазмените концентрации на TNF-α, свързани с изявата на пароксизмалното предсърдно мъждене (ППМ).Материал и методи: Плазмените концентрации на TNF-α бяха измерени трикратно при 51 пациенти (26 мъже и 25 жени; средна възраст 59.84 1.60 г) с ППМ, a именно: незабавно след хоспитализацията им (т.е. по време на ритъмното нарушение), 24 часа и 28 дни след възстановяване на синусов ритъм. Показателят беше измерен еднократно при 52 контроли (26 мъже и 26 жени; средна възраст 59.50 1.46 г.) без анамнестични или електрокардиографски данни за ПМ до момента. Плазмените концентрации на TNF-α бяха определени с ELISA кит (Elabscience Biotechnology Co., Ltd, China). Синусов ритъм бе възстановен медикаментозно с propafenone.Резултати: При постъпване на пациентите в отделението концентрациите на TNF-α бяха повишени спрямо тези на контролите (15.06 0.81 vs 8.20 0.29 pg/mL, p<0.001). Двадесет и четири часа след възстановяване на синусов ритъм промените персистираха (13.09 0.70 vs 8.20 0.29 pg/mL, p<0.001). На двадесет и осмия ден липсваше значима разлика (9.21 0.54 vs 8.20 0.29 pg/mL, p=0.10).Заключение: При ППМ се наблюдават динамични промени в плазмените концентрации на TNF-α. Те са значимо повишени по време на клиничната изява на ритъмното нарушение. След възстановяване на синусов ритъм те се нормализират бавно във времето. Специфичният характер на установените отклонения дават сериозно основание да се приеме клиничната им значимост за изявата на заболяването.Introduction: Atrial fibrillation is the most common arrhythmia in clinical practice. There has been a growing body of evidence in recent years of the role of inflammatory cytokines in the pathogenesis of the rhythm disorder, although the studies have been predominantly in the field of persistent and permanent atrial fibrillation. Aim: To find changes in plasma concentrations of TNF-α, concerning the clinical manifestation of paroxysmal atrial fibrillation. Materials and Methods: Plasma concentrations of IL-6 were measured three times in 51 patients (26 men and 25 women; mean age 59.84 1.60 yrs) with paroxysmal atrial fibrillation: once immediately after hospitalization of these patients (that is, during the rhythm disorder episode at baseline), then at 24 hours and finally 28 days after restoration of sinus rhythm. The plasma concentration was measured only once in the control group of 52 control subjects (26 men, 26 women; mean age 59.50 1.46 yrs). We used ELISA kit to determine the IL-6 concentrations. The sinus rhythm was restored with propafenone for all patients. Results: Baseline plasma concentrations of IL-6 were higher than those of controls (15.06.38 0.81 vs 8.20 0.29 pg/mL, p<0.001). The difference was retained for 24 hours after sinus rhythm restoration of (13.09 0.70 vs 8.20 0.29 pg/mL, p<0.001). At 28 days there was no statistically significant difference between patients and controls (9.21 0.54 vs 8.20 0.29 pg/mL, p=0.10). Conclusion: Dynamic changes of TNF-α plasma concentrations were established in paroxysmal atrial fibrillation. The cytokine levels were significantly elevated during the clinical manifestation of the arrhythmia. They decreased slowly after restoration of sinus rhythm. The changes we found provide a strong rationale to suggest that they are most likely relevant to the clinical manifestaton of paroxysmal atrial fibrillation

Interleukin response in cardiovascular diseases: an overview

Interleukins are important modulators of the immune response in the human body, which inevitably makes them participants in the intimate mechanisms of various diseases. Cardiovascular morbidity and mortality is high in the world as a whole, despite the ongoing primary and secondary prevention. Therefore their pathogenetic mechanisms are of significant research and clinical interest. A number of studies demonstrated changes in the interleukin status of patients with coronary heart disease, heart failure, some cardiomyopathies and rhythm conduction disorders. Significantly altered levels of basic for the immunity pro-inflammatory and anti-inflammatory cytokines were found. It was even proven, that some of them have predictive value for the manifestation of certain diseases. All this is a reason to allow interleukins to take part in the intimate mechanisms of cardiovascular diseases and consider the place of interleukin blockers in the treatment of these diseases

Dynamics of oxidative status in patients with paroxysmal atrial fibrillation

Introduction: Studies have established oxidative disorders in persistent and permanent atrial fibrillation. Our aim was to investigate oxidative status still in the early hours of paroxysmal atrial fibrillation (PAF) and monitor its changes after sinus rhythm (SR) restoration. Material and Methods: Levels of malondialdehyde and total glutathione were determined in plasma (Pl-MDA; Pl-GSH) and erythrocytes (Er-MDA; Er-GSH) together with erythrocyte glutathione peroxidase activity (GSH-Px) in 51 patients (59.84±1.6 years, 26 males). Markers were investigated upon hospital admission, 24 hours and 28 days after SR restoration. They were also determined in 52 healthy subjects (59.50±1.46 years, 26 males). Results: Mean AF duration prior to hospitalization was 8.14±0.76 hours. Upon admission, Pl-MDA and Er-MDA were significantly increased (p0.05). Conclusion: Disorder of oxidative status is detected in the early hours of PAF, which persists after SR restoration. Oxidative balance is restored slowly with time. This specific dynamics of oxidative status is most likely related to AF clinical course, namely to its manifestation and recurrences

Фактори, влияещи върху вариабилността на сърдечната честота

The heart rate is individual for each person and it is influenced by various factors that lead to its increase or decrease. Good cardiac function is a prerequisite for a healthy life, and heart rate variability (HRV) analysis is a powerful tool for assessing the autonomic nervous system (ANS), in which the sympathetic and parasympathetic systems interact to regulate cardiac function of the vascular system. A high HRV is associated with a good state of health, while a low HRV is associated not only with pathological conditions in the activity of the cardiovascular system, but also with a number of other factors, such as: overweight, type 2 diabetes, stress and others. Tracking HRV over time and matching segments of data related to specific activities or life events can provide unique information about a person's physical and psychological health. On the basis of the obtained results, it can be concluded that the indices of HRV can be used as non-specific indicators of the impact of factors of a different nature on the human body.Научното изследване е проведено като част от проекта „Изследване на приложението на нови математически методи за анализ на кардиологични данни“ № КП-06-Н22/5 от 07.12.2018 г., финансиран от Фонд „Научни Изследвания“

Early Deviations in the Coagulation and Fibrinolytic System in Paroxysmal Atrial Fibrillation // Пароксизмално предсърдно мъждене – ранни отклонения в коагулационна и фибринолитична система

This thesis presents for the first time convincing clinical and laboratory data for the development of hypercoagulability in the first 24 hours of paroxysmal atrial fibrillation caused by significant deviations in the coagulation and fibrinolytic system. Brief (≤24 hours) episodes of the disease are clearly defined as a prothrombotic state, even in low-risk thromboembolic characteristics of patients (CHA2DS2-VASc score = 0 in men/1 in women). Episode duration affects the established haemostatic deviations. The presented dissertation has not only original scientific value but also clearly outlines clinical applications of the results. It shows that FXIa and FXIIa are more promising targets for effective and safer anticoagulation than currently established. It indicates the need for post-procedural anticoagulation even after currently considered lowest risk episodes of non-valvular paroxysmal atrial fibrillation (≤ 24 hours and CHA2DS2-VASc score = 0 in men/1 in women). It outlines the first 6 hours of the disease as having a lower periprocedural thromboembolic risk. It outlines possibilities for clinical application of some haemostatic indicators beyond haemostatic assessment, namely, the possibility of predicting manifestation of paroxysmal atrial fibrillation by plasminogen plasma activity and t-PA plasma levels and resulting ischemic stroke complications by TF, FVIII and vitronectin plasma levels.В настоящия дисертационен труд за първи път са представени убедителни клинико-лабораторни данни за развитие на хиперкоагулабилитет в първите 24 часа на пароксизмално предсърдно мъждене, следствие на значими отклонения в коагулационна и фибринолитична система. Кратките (≤24 часа) епизоди на заболяването са ясно очертани като протромбозно състояние, дори при нискорискова тромбоемболична характеристика на пациентите (CHA2DS2-VASc score = 0 при мъже или 1 при жени). Давността на епизода оказва ефект върху установените хемостазни отклонения. Представеният дисертационен труд има не само оригинална научна стойност, но очертава ясно и клиничното приложение на получените резултати. Показва FXIа и FXIIа като обещаващи цели за ефективна и по-безопасна антикоагулация сравнено с утвърдената към момента. Показва необходимост от постпроцедурна антикоагулация дори след считаните към момента най-нискорискови епизоди на неклапно пароксизмално предсърдно мъждене (давност ≤ 24 часа и CHA2DS2-VASc score = 0 при мъже или 1 при жени). Очертава първите 6 часа на заболяването като времевия интервал, дефиниращ по-нисък перипроцедурен тромбоемболичен риск. Очертава възможности за клинично приложение на някои хемостазни показатели отвъд хемостазната оценка, а именно възможност за предикция изявата на пароксизмално предсърдно мъждене чрез плазмена активност на плазминоген и плазмени нива на t-PA и на неговото усложнение исхемичен мозъчен инсулт чрез плазмени нива на TF, FVIII и витронектин

Dynamics of oxidative status in paients with paroxysmal atrial fibrillation.// Динамика в оксидативния статус при пациенти с пароксизмално предсърдно мъждене.

[EN] Oxidative status in atrial fibrillation (AF) was analyzed mainly in patients with persistent or permanent type of the arrhythmia. Data on paroxysmal AF are scarce that gives us ground to specify the aim of the dissertation: to investigate the oxidative status in patients with paroxysmal AF and monitor its changes after sinus rhythm restoration. For that reason prooxidant and antioxidant system was studied in dynamics: during the episode of AF, 24 hours and 28 days after the rhythm disorder was terminated. Ten markers were measured by colourimetric enzymatic essay and atomic absorbtion spectrometry: levels of malondialdehyde and glutathione in plasma and erythrocites, activity of superoxide dismutase, catalase, glutathione peroxidase, glucose-6-phosphate dehydrogenase, ceruloplasmin and serum levels of copper. The results are original in their character. For the first time oxidative stress, result of enhanced prooxidant precesses and decreased antioxidant defence system, were established still in the early hours (up to the 24th hour) of paroxysmal atrial fibrillation; the oxidative balance recovered slowly after sinus rhythm restoration – till the 28th day after tha arrhythmia termination. For the first time copper deficiency was established during episode of paroxysmal AF, most probably closely related with the initiating mechanisms of the arrhythmia. Six markers appeared to be predictive for the AF appearance and precise mathematical models were created to calculate the possibility of the disorder development. New approach of antioxidant treatment in paroxysmal AF was suggested.[BG] Оксидативният статус при пациенти с предсърдно мъждене (ПМ) е анализиран предимно при персистиращо и перманентно ПМ. Това определи целта на настоящия дисертационен труд: да се изследва оксидативния статус при пациенти с пароксизмално ПМ и се проследят промените в него след възстановяване на синусов ритъм. Проучи се състоянието на прооксидантна и антиоксидантна система по време на ПМ, 24 часа и 28 дни след възстановяване на синусов ритъм. Чрез спектрофотометричен метод и директна пламъкова атомноабсорбционна процедура бяха изследвани едновременно десет показателя: нива на малондиалдехид и глутатион в плазма и еритроцити, активност на супероксид дисмутаза, каталаза, глутатион пероксидаза, глюкозо-6-фосфат дехидрогеназа, церулоплазмин и серумен мед. Получените резултати притежават изцяло оригинален характер. За първи път при пароксизмално ПМ се установява оксидативен стрес още до 24-я час след клиничната му изява, следствие на засилени прооксидантни процеси и понижени антиоксидантни механизми и възстановяване на оксидативния баланс бавно във времето – до двадесет и осем дни след епизода на ПМ. За първи път е показан меден дефицит при изявата на заболяването и е потърсена връзка с иницииращите го механизми. Установено е, че шест от показателите са предиктивни за изявата на пароксизмално ПМ и са представени математически модели за изчисляване вероятността за развитие на заболяването. Направено е предложение за нов подход при антиоксидантното лечение

ECG Changes in Patients with Hypothermia

Introduction: Hypothermia is defined as a condition, in which the body core temperature is below 35°C. The most common causes are due to environmental circumstances, e.g. exposure to cold weather. Non-environmental causes are uncommon, but also should be taken into consideration, e.g. hypothermia with diabetic ketoacidosis. Our aim is to draw attention to the changes in the electrocardiogram (ECG), which are characteristic for the patients with hypothermia.Materials and Methods: We conducted a literature review using Pub Med, Google Scholar, and MedlinePlus databases from 1984 until March 2016. We used keywords like hypothermia, ECG in hypothermia, cases of hypothermia and accidental hypothermia. We included reviews published in journals with evidence-based medical publications.Results: In a normal 12-lead ECG obtained from a hypothermic patient, a broad spectrum of changes can be observed, they could be confusing and necessitating some extra tests and exams. Some of them may seem similar to those found in acute coronary ischaemia and pericarditis. The T wave can show varied differences, e.g. the T wave can be negative in lead V2-V6. PR, QT and QRS intervals can be differently prolonged. Most specific for hypothermia is the J point elevation, also called Osborne wave, an extra elevation after the QRS complex. The wave correlates directly with the body temperature, the amplitude increases with the decreasing temperature.Hypothermic patients may present with different atrial or ventricle rhythm disorders. Bradyarrhythmias are typical of those patients incl. atrial fibrillation with slow ventricular response, varying degrees of AV block, etc.All ECG changes disappear after rewarming the patients.Conclusion: Hypothermia often results in ECG changes, and should be recognised by the emergency doctors, because they have a diagnostic and prognostic importance. The special findings should be detected as early as possible to provide patients the correct treatment

Correlation between oral hygiene and health status of patients with cardiovascular diseases

Introduction: There are a number of studies in the scientific literature about the influence of endodontic pathology on the health status of patients with chronic non-communicable diseases. Diabetics have long been known to suffer from inflammatory periodontal diseases, caries and its complications. There are data that patients with cardiovascular disease also have more frequent oral pathology. More often dentists find a link between patients' dental problems and their chronic illnesses, but there are few studies on the correlation between oral hygiene and the health status of patients with cardiovascular disease.Aim: The aim of this article is to assess whether there is and what the correlation between oral hygiene and health status in patients with cardiovascular diseases is, in order to prevent their dental or general health.Materials and Methods: Forty patients with cardiovascular diseases were examined. The study used: a documentary method (patients' medical documents), a survey method, and a clinical dental examination.Results: During the dental examination we found a significant correlation between bleeding gums and the presence of cardiovascular diseases. In smokers, oral hygiene and brushing teeth were very neglected. Survey data showed that less frequent brushing of teeth is more common among men, older patients and those who are overweight. Patients with lower body weight who followed a diet and healthy eating also had better oral hygiene. A total of 61% of the patients reported a visit to their dentist in the last year. Most respondents (72%) had at least one dental problem, but only 12% received adequate information from their dentist about their oral health.Conclusion: Our results confirm the positive correlation between oral hygiene and the health status of patients with cardiovascular diseases, therefore it is important for dentists to train more actively such patients to improve their oral hygiene, which would improve their overall health