Alterations of cardiovascular complexity during acute exposure to high altitude: A multiscale entropy approach

Stays at high altitude induce alterations in cardiovascular control and are a model of specific pathological cardiovascular derangements at sea level. However, high-altitude alterations of the complex cardiovascular dynamics remain an almost unexplored issue. Therefore, our aim is to describe the altered cardiovascular complexity at high altitude with a multiscale entropy (MSE) approach. We recorded the beat-by-beat series of systolic and diastolic blood pressure and heart rate in 20 participants for 15 min twice, at sea level and after arrival at 4554 m a.s.l. We estimated Sample Entropy and MSE at scales of up to 64 beats, deriving average MSE values over the scales corresponding to the high-frequency (MSEHF) and low-frequency (MSELF) bands of heart-rate variability. We found a significant loss of complexity at heart-rate and blood-pressure scales complementary to each other, with the decrease with high altitude being concentrated at Sample Entropy and at MSEHF for heart rate and at MSELF for blood pressure. These changes can be ascribed to the acutely increased chemoreflex sensitivity in hypoxia that causes sympathetic activation and hyperventilation. Considering high altitude as a model of pathological states like heart failure, our results suggest new ways for monitoring treatments and rehabilitation protocols

A rare presentation of immune thrombocytopenic purpura

Immune thrombocytopenic purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without any apparent cause. Some patients may be diagnosed during routine blood investigations or may present with bleeding diathesis. Treatment required for moderate to severe thrombocytopenia or those with bleeding manifestations. We present a case of 43 year old male, sputum positive pulmonary tuberculosis on isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E) (HRZE) with persistent thrombocytopenia. He developed hepatitis hence isoniazid (INH) and rifampicin were stopped. He had fever, rash, purpura, hematuria and blood tinged sputum with platelet count of 10,000. 4 random donor platelets (RDPs) given. He suffered from mild COVID-19 infection and recovered in 2 weeks but platelets remained low. Bone marrow examination was suggestive of ITP. Inspite of steroid therapy no improvement was seen. Later was treated with injection romiplostim, and started on systemic lupus erythematosus (SLE) regimen for tuberculosis and discharged with regular follow up. Last platelet count being 1,20000/dl, liver function tests normal and now restarted on HRZE

Diabetic nephropathy: early markers for monitoring and prevention

Background: Type 2 diabetes, with its complications is perpetually on the rise more so in India .Diabetic Nephropathy progresses silently, and manifests at a stage where, patient can be offered only renal replacement. This study was undertaken to detect early markers of Diabetic Nephropathy. Aims and objective of the study was to study early nephropathy by UACR (urinary albumin/creatinine ratio), RFT (renal function test) and e-GFR in Type 2 diabetic patients of more than 2 years duration, with and without hypertension.Methods: A hospital based cross-sectional observational study, of 100 patients, 18-60 years of age, of type 2 Diabetes of 2 year duration and above, of which 50 were only diabetic and 50 had diabetes and hypertension. Patients who had an established renal disease were excluded from study.Results: Our study of 100 patients, 18-60 years of age, had 23 male and 77 female patients. Maximum patients were in age group 41-50 years, and 52% had diabetes of 2-4 years duration. Of the renal parameters studied, BUN was normal in 72% and S. Creatinine normal in 67%. UACR was normal in only 38%, and e-GFR was normal in 49%.Conclusions: In our study age and sex, duration of Diabetes and HbA1c did not have any bearing on renal parameters. UACR followed by e-GFR, were deranged early. UACR was more deranged in diabetics with hypertension.

Sarcoidosis presenting as Lofgran’s syndrome

A 40 year old male, first presented with erythema nodosum, fever, weight loss and joint pains and did not respond to anti-tubercular treatment. One year later he came back with joint pains, erythema nodosum, fever and dry cough. He also had weakness in distal right lower limb more than left limb. He had raised ESR, hypocalcaemia, raised ACE levels and lymphnode involvement on HRCT, with skin biopsy suggestive of sarcoidosis. This time patient responded to treatment and is on regular follow up

Machine Learning in Hypertension Detection: A Study on World Hypertension Day Data.

Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection. We aimed to explore whether a machine learning (ML) algorithm can help identifying individuals predictors of hypertension. We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. A total of 20206 individuals have been included for analysis. We tested five ML algorithms, exploiting different balancing techniques. Moreover, we computed the performance of the medical protocol currently adopted in the screening programs. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others. However, Random Forest provides interesting performances (0.818 sensitivity - 0.629 specificity) compared with medical protocols (0.906 sensitivity - 0.230 specificity). Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models

2019 Italian Society of Cardiology census on telemedicine in cardiovascular disease : a report from the working group on telecardiology and informatics

Background The aim of this study was to assess by a census supported by the Italian Society of Cardiology (Societ\ue0 Italiana di Cardiologia, SIC) the present implementation of telemedicine in the field of cardiovascular disease in Italy. Methods A dedicated questionnaire was sent by email to all the members of the SIC: data on telemedicine providers, service provided, reimbursement, funding and organisational solutions were collected and analysed. Results Reported telemedicine activities were mostly stable and public hospital based, focused on acute cardiovascular disease and prehospital triage of suspected acute myocardial infarction (prehospital ECG, always interpreted by a cardiologist and not automatically reported by computerised algorithms). Private companies delivering telemedicine services in cardiology (ECGs, ambulatory ECG monitoring) were also present. In 16% of cases, ECGs were also delivered through pharmacies or general practitioners. ICD/CRT-D remote control was performed in 42% of cases, heart failure patient remote monitoring in 37% (21% vital parameters monitoring, 32% nurse telephone monitoring). Telemedicine service was public in 74% of cases, paid by the patient in 26%. About half of telemedicine service received no funding, 17% received State and/or European Union funding. Conclusions Several telemedicine activities have been reported for the management of acute and chronic cardiovascular disease in Italy. The whole continuum of cardiovascular disease is covered by telemedicine solutions. A periodic census may be useful to assess the implementation of guidelines recommendations on telemedicine

A successful experimental model for intimal hyperplasia prevention using a resveratrol eluting balloon

Objective: Restenosis due to intimal hyperplasia is a major clinical problem that compromises the success of angioplasty and endovascular surgery. Resveratrol (RSV) has demonstrated a beneficial effect on restenosis from angioplasty. Unfortunately, the physicochemical characteristics of RSV reduce the practicality of its immediate clinical application. This work proposes an experimental model aiming to setup an intravessel, elutable, RSV-containing compound. Methods: A 140 mg/mL RSV sterile injectable solution with a suitable viscosity for intravascular administration by drugdelivery catheter (RSV-c) was prepared. This solution was locally administered in the common iliac artery of adult male New Zealand White rabbits using a dedicated device (Genie; Acrostak, Geneva, Switzerland) after the induction of intimal hyperplasia by traumatic angioplasty. The RSV concentrations in the wall artery were determined, and the thickness of the harvested iliac arteries was measured over a 1-month period. Results: The Genie catheter was applied in rabbit vessels, and the local delivery resulted in an effective reduction in restenosis after plain angioplasty. Notably, RSV-c forced into the artery wall by balloon expansion might accumulate in the interstitial areas or within cells, avoiding the washout of solutions. Magnification micrographs showed intimal proliferation was significantly inhibited when RSV-c was applied. Moreover, no adverse events were documented in in vitro or in vivo studies. Conclusions: RSV can be advantageously administered in the arterial walls by a drug-delivery catheter to reduce the risk of restenosis

Use of artificial intelligence to automatically predict the optimal patient-specific inversion time for late gadolinium enhancement imaging. Tool development and clinical validation

Introduction With the worldwide diffusion of cardiac magnetic resonance (CMR), demand on image quality has grown. CMR late gadolinium enhancement (LGE) imaging provides critical diagnostic and prognostic information, and guides management. The identification of optimal Inversion Time (TI), a time-sensitive parameter closely linked to contrast kinetics, is pivotal for correct myocardium nulling. However, determining the optimal TI can be challenging in some diseases and for less experienced operators. Purpose To develop and test an artificial intelligence tool to automatically predict the personalised optimal TI in LGE imaging. Methods The tool, named THAITI, consists of a Random Forest regression model. It considers, as input parameters, patient-specific TI determinants (age, gender, weight, height, kidney function, heart rate) and CMR scan-specific TI determinants (B0, contrast type and dose, time elapsed from contrast injection). THAITI was trained on 219 patients (3585 images) with mixed conditions who underwent CMR (1.5T; Gadobutrol; averaged, MOCO, free-breathing true-FISP IR [1]) for clinical reasons. The dataset was split with a 90–10 policy: 90% of data for training, and 10% for testing. THAITI’s hyperparameters were optimised by embedding k-fold cross validation into an evolutionary computation algorithm, and the best performing model was finally evaluated on the test set. A graphical user interface was also developed. Clinical validation was performed on 55 consecutive patients, randomised to experimental (THAITI-set TI) vs control (operator-set TI) group. Image quality was assessed blindly by 2 independent experienced operators by a 4-points Likert scale, and by means of the contrast/enhancement ratio (CER) (i.e., signal intensity of enhanced/remote myocardium ratio). Results In the testing set, the TI predicted by THAITI differed from the ground truth by ≥ 5ms in 16% of cases. At clinical validation, myocardial nulling quality did not differ between the experimental vs the control group either by CER or visual assessment, with an overall "optimal" or "good" nulling in 96% vs 93%, respectively. Conclusions Using main determinants of contrast kinetics, THAITI efficiently predicted the optimal TI for CMR-LGE imaging. The tool works as a stand-alone on laptops/mobile devices, not requiring adjunctive scanner technology and thus has great potential for diffusion, including in small or recently opened CMR services, and in low-resource settings. Additional development is ongoing to increase generalisability (multi-vendor, multi-sequence, multi-contrast) and to test its potential to further improve CMR-LGE image quality and reduce the need for repeated imaging for inexperienced operators. Figure 1. Top: THAITI interface. Bottom: examples of experimental group CMR-LGE imaging. Table 1. Control vs experimental group. Data expressed as absolute number (%), mean ± SD, median [IQR]. ⧧ T-test; * Chi-square

Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alone

Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alon