Evidence against a myocardial factor as the cause of left ventricular dilation in active rheumatic carditis

AbstractObjectives. The aim of this study was to determine whether left ventricular dilation and congestive heart failure in patients with acute rheumatic fever with carditis are accompanied by left ventricular contractile dysfunction.Background. Acute rheumatic fever with carditis involves both the myocardium and endocardium, with consequent valvular regurgitation. The relative contribution of volume overload induced by valvular regurgitation and myocardial dysfunction due to rheumatic myocarditis to the overall degree of left ventricular dilation and congestive heart failure in these patients is unknown.Methods. To investigate this, we evaluated 32 patients (15 male, 17 female, mean age 14 ± 3 years) with documented active carditis and congestive heart failure. All 32 patients were found to have significant isolated mitral regurgitation or combined mitral and aortic regurgitation. Echocardiographic analysis of left ventricular dimensions and systolic performance was performed before and after isolated mitral or combined mitral and aortic valve replacement and the results were compared with those in 19 control subjects matched for age, gender and body surface area.Results. Both preoperative left ventricular end-diastolic diameter and percent fractional shortening were significantly increased in patients compared with control subjects (57 ± 7 vs. 43 ± 3 mm, p < 0.001, and 38 ± 6% vs. 33 ± 1%, p < 0.001, respectively). After valve replacement, left ventricular end-diastolic diameter decreased significantly (57 ± 7 to 47 ± 6 mm, p < 0.001). Although percent fractional shortening decreased significantly postoperatively (38 ± 6% to 32 ± 6%, p < 0.001), the postoperative percent fractional shortening did not differ from that in control subjects (32 ± 6% vs. 33 ± 1%, p = NS).Conclusions. The results of this study indicate that left ventricular dilation and heart failure in patients with acute rheumatic carditis rarely occur in the absence of hemodynamically significant regurgitant valve lesions. Furthermore, rapid reduction in left ventricular dimensions and preservation of fractional shortening after isolated mitral or combined mitral and aortic valve replacement suggest that rheumatic carditis is not accompanied by any significant degree of myocardial contractile dysfunction

Excessive vasoconstriction in rheumatic mitral stenosis with modestly reduced ejection fraction

AbstractObjectives. The primary hypothesis examined was that underfilling due to inflow obstruction accounts for modestly depressed ejection performance in mitral stenosis, Having found little evidence to support this hypothesis, we sought to determine other factors that might differentiate patients with different levels of ejection performance.Methods. Ventricular load and performance were compared in two groups of patients before and immediately after successful balloon valvuloplasty that was not complicated by mitral regurgitation: those in whom prevalvuloplasty ejection fraction was ≥0.55 (group I, n = 10) and those in whom it was <0.55 (group II, n =11).Results. Before valvuloplasty, mitral valve area was less in group II (0.65 cm2) than in group I (0.84 cm2, p = 0.02), but end-diastolic pressure (12 vs. 12 mm Hg in group I), end-diastolic wall stress (46 vs. 44 kdynes/cm2in group I) and end-diastolic volume (152 vs. 150 ml in group I) were not less in group II, nor were these variables significantly reduced compared with those of a normal control group. In group II, end-systolic volume was larger (77 vs. 55 ml in group I, p = 0.001) and cardiac output was less (3.1 vs. 3.6 liters/min in group I, p = 0.03), possibly owing to higher systemic vascular resistance (2,438 vs. 1,921 dynes·s·cm−5in group I, p = 0.05) and end-systolic wall stress (273 vs. 226 kdynes/cm2in group I, p = 0.06), although mean arterial pressure in the two groups was similar (91 vs. 84 mm Hg in group I, p = 0.22). Group II patients also had higher values for pulmonary vascular resistance (712 vs. 269 dynes·s·cm−5in group I, p = 0.03) and mean pulmonary artery pressure (47 vs. 29 mm Hg in group I, p = 0.02) despite similar values for mean left atrial pressure (20 vs. 18 mm Hg in group I, p = 0.35). After valvuloplasty, mitral valve area increased by 2.5- and 3-fold, respeditely, in group I (to 2.1 cm2and group II (to 2.0 cm2). Modest increases in left ventricular end-diastolic pressure, end-diastolic stress and end-diastolic volume (+9%) after valvuloplasty were statistically significant only for group II. End-systolic wall stress did not decline in either group II (281 kdynes/cm2) or group I (230 kdynes/cm2), and ejection fraction failed to increase significantly (0.49 to 0.51 for group II and 0.62 to 0.61 for group I) after valvuloplasty. Contractile performance estimated with a preload-corrected ejection fraction-afterload relation was within or near normal limits in all 19 patients in whom it was assessed.Conclusions. Excessive vasoconstriction may account for the higher afterload, lower ejection performance and tower cardiac output observed in a subset of patients with mitral stenosis because contractile dysfunction could not be detected and left ventricular filling—which was not subnormal despite severe inflow obstruction—improved only modestly after valvuloplasty

Factores de la decisión de compra de las mujeres de 18 a 25 años en las tiendas de ropa de moda de Real Plaza Chiclayo 2019

En cierto sentido las empresas siempre están preocupadas por alcanzar cifras de ventas que les aporten beneficios y también les interesa el desarrollo eficiente de las estrategias de marketing, y para ello tienen la necesidad de saber cuáles son los elementos que inciden en las decisiones de compra de los consumidores. Es por esto que se planteó como objetivo de esta investigación determinar los factores que tienen mayor incidencia en la decisión de compra de las mujeres de 18 a 25 años en las tiendas de ropa de moda de Real Plaza, Chiclayo 2019. Además, se siguió el paradigma cuantitativo, de tipo descriptivo. La muestra estuvo conformada por 196 mujeres de 18 a 25 años que realizan compras de ropa de moda en las tiendas de Real Plaza, a las que se les aplicó un cuestionario de 18 preguntas las mismas que sirvieron además para definir el perfil sociodemográfico de las compradoras de estas tiendas. El instrumento utilizado fue analizado por 3 expertos. Se obtuvo como resultado que los factores externos son los que mayor incidencia tienen en la decisión de compra de las mujeres de 18 a 25 años, además que el factor externo que más incide es la Comunicación y el factor interno es la Percepción. Respecto al perfil sociodemográfico de la muestra de 196 mujeres de 18 a 25 años encuestadas, se determinó que el 51% procede del mismo Chiclayo, así como también que el 65.8% no trabaja y el 34.2% restante si lo hace; el sueldo que obtienen oscila entre los s/. 850 y 1300.TesisComunicación y desarrollo human

ANALISIS PREDIKSI KEBANGKRUTAN DENGAN METODE ALTMAN Z-SCORE (Studi pada Perusahaan PT. HM Sampoerna, Tbk dan pada PT. Gudang Garam, Tbk. yang terdaftar di Bursa Efek Indonesia (BEI) Periode 2018-2019)

ABSTRACT The purpose of this study was to predict the level of bankruptcy in PT. HM Sampoerna, Tbk. and PT. Gudang Garam, Tbk. The type of data used is qualitative data and quantitative data. The data source used secondary data. The analytical method used is the Altman Z-Score method. The results of this study indicate that the results of the analysis of the Altman Z-Score on PT. HM Sampoerna, Tbk.and PT. Gudang Garam, Tbk. warehouse. In 2018-2019 shows good result, where both of these companies have Z-Score above 2,6. At PT. HM Sampoerna, Tbk. in 2018 the Z-Score was 12,0816 > 2,6. And in 2019 the Z-Score was 10,5251 > 2,6. While in PT. Gudang Garam ,Tbk. in 2018 the Z-Score was 7,3407 > 2,6 and in 2018 the Z-Score was 7,5251 > 2,6. So in the calculation of the Altman Z-Score model Altman Z-Score model that can predict bankruptcy Z-Score > 2,6 which in indicate by the company in a safe condition or non bankrupt. Keywords: Altman Z-score, bankruptcy prediction ABSTRAK Tujuan penelitian ini adalah untuk memprediksi tingkat kebangkrutan pada PT. HM. Sampoerna, Tbk. dan PT. Gudang Garam, Tbk. Jenis data yang digunakan adalah data kualitatif dan data kuantitatif. Sumber data yang digunakan adalah data sekunder. Metode analisis yang digunakan adalah metode Altman Z-Score. Hasil penelitian ini menunjukkan bahwa hasil analisis model Altman Z-Score pada PT. HM. Sampoerna, Tbk. dan PT. Gudang Garam, Tbk. pada Tahun 2018-2019 menunjukkan hasil yang baik, dimana kedua perusahaan ini memiliki nilai Z-Score diatas 2,6. Pada PT. HM. Sampoerna, Tbk. tahun 2018 nilai Z-Score 12,0816 > 2,6, dan tahun 2019 nilai Z-Score 10,5415 > 2,6. Sedangkan pada PT. Gudang Garam, Tbk. tahun 2018 nilai Z-Score 7,3407 > 2,6, dan tahun 2019 nilai Z-Score 7,5251 > 2,6. Sehingga dalam perhitungan model Altman Z-Score yang dapat memprediksi kebangkrutan nilai Z-Score > 2,6 yang ditunjukkan oleh perusahaan dalam kondisi aman atau tidak mengalami kebangkrutan. Kata kunci : Altman Z-Score, prediksi kebangkrutan

The relationship between the nitric oxide synthase gene and the risk of hypertension defi ned according to ambulatory blood pressures

Although nitric oxide (NO) plays an important role in blood pressure (BP) control, whether variation of genes involved in regulating the synthesis of NO infl uences BP is uncertain. As the heritability of BP is stronger for ambulatory than it is for conventional BP, we assessed the independent association of the well described functional exon 7 Glu298Asp variant of the eNOS gene with the presence of hypertension in 511 randomly selected normotensive control participants and 503 hypertensives with a diagnosis of hypertension confi rmed with 24-hour ambulatory BP profiles whilst off therapy. We also assessed the relationship between eNOS genotype and 24 hour ambulatory BP. Comparisons of genotype and allele frequencies indicated a lack of association of the exon 7 Glu298Asp gene variant with hypertension (Odds ratio of genotype predicting the presence of hypertension=0.97, confidence interval=0.70-1.30, p=0.92). However, patients with the Glu/Glu genotype of the Glu298Asp variant (n=424) had increased 24-hour systolic and diastolic blood pressures (152±1/97±1 mm Hg) in comparison to patients heterozygous for the Glu298Asp variant or homozygous for the 298Asp allele (n=79) (145±1/94±1 mm Hg, p‹0.005 for systolic BP and p‹0.001 for diastolic BP after multiple adjustments including age, gender, body mass index and the presence of diabetes mellitus). Differences in systolic and diastolic BP between genotype groups were noted during the day as well as at night. The association of eNOS genotype with ambulatory BP translated into an increased risk of more severe grades of hypertension in patients with the Glu/Glu genotype (grade II and III vs. grade I, Odds ratio=2.20, confidence interval=1.34-3.59, p‹0.0002). In conclusion, a functional gene variant (Glu298Asp) at the eNOS locus contributes ~1.4-2.5% to the variation in ambulatory blood pressure within hypertensives, but is not associated with the presence of hypertension in patients in whom the diagnosis has been confirmed by 24-hour ambulatory BP values. The relationship between eNOS genotype and 24-hour ambulatory BP and the severity of hypertension warrants further study

Comparison of indapamide and low-dose hydrochlorothiazide monotherapy in black patients with mild to moderate hypertension

No Abstract

Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure

ObjectivesThe purpose of this research was to evaluate the therapeutic value of initiating a beta-blocker before an angiotensin-converting enzyme inhibitor (ACEI) in the treatment of heart failure.BackgroundAlthough ACEI and carvedilol produce benefits in heart failure, whether the order of initiation of therapy determines the impact on left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined.MethodsA single-center, prospective, randomized, open-label study was performed. We evaluated whether initiation of therapy with carvedilol either before (n = 38) or after (n = 40) perindopril therapy in newly diagnosed patients in NYHA FC II to III heart failure with idiopathic dilated cardiomyopathy, with the addition of the alternative agent after six months, determined subsequent changes in NYHA FC and LV function (echocardiography and radionuclide ventriculography). Study drugs were titrated to maximum tolerable doses.ResultsThere were no differences in baseline characteristics between the study groups. After 12 months 11 patients died (6 in the group where the ACEI was initiated). At 12 months the group receiving carvedilol as initial therapy achieved a higher tolerable dose of carvedilol (43 ± 17 mg vs. 33 ± 18 mg, p = 0.03); a lower dose of furosemide (p &lt; 0.05); and better improvements in symptoms (NYHA FC, p &lt; 0.002), LV ejection fraction (radionuclide: 15 ± 16% vs. 6 ± 13%, p &lt; 0.05; echocardiographic, p &lt; 0.01), and plasma N-terminal pro-brain natriuretic peptide concentrations (p &lt; 0.02).ConclusionsAs opposed to the conventional sequence of drug use in the treatment of heart failure, initiation of therapy with carvedilol before an ACEI results in higher tolerable doses of carvedilol and better improvements in FC and LV function

Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon

Using machine learning to identify patient characteristics to predict mortality of in-patients with COVID-19 in south Florida

IntroductionThe SARS-CoV-2 (COVID-19) pandemic has created substantial health and economic burdens in the US and worldwide. As new variants continuously emerge, predicting critical clinical events in the context of relevant individual risks is a promising option for reducing the overall burden of COVID-19. This study aims to train an AI-driven decision support system that helps build a model to understand the most important features that predict the “mortality” of patients hospitalized with COVID-19.MethodsWe conducted a retrospective analysis of “5,371” patients hospitalized for COVID-19-related symptoms from the South Florida Memorial Health Care System between March 14th, 2020, and January 16th, 2021. A data set comprising patients’ sociodemographic characteristics, pre-existing health information, and medication was analyzed. We trained Random Forest classifier to predict “mortality” for patients hospitalized with COVID-19.ResultsBased on the interpretability of the model, age emerged as the primary predictor of “mortality”, followed by diarrhea, diabetes, hypertension, BMI, early stages of kidney disease, smoking status, sex, pneumonia, and race in descending order of importance. Notably, individuals aged over 65 years (referred to as “older adults”), males, Whites, Hispanics, and current smokers were identified as being at higher risk of death. Additionally, BMI, specifically in the overweight and obese categories, significantly predicted “mortality”. These findings indicated that the model effectively learned from various categories, such as patients' sociodemographic characteristics, pre-hospital comorbidities, and medications, with a predominant focus on characterizing pre-hospital comorbidities. Consequently, the model demonstrated the ability to predict “mortality” with transparency and reliability.ConclusionAI can potentially provide healthcare workers with the ability to stratify patients and streamline optimal care solutions when time is of the essence and resources are limited. This work sets the platform for future work that forecasts patient responses to treatments at various levels of disease severity and assesses health disparities and patient conditions that promote improved health care in a broader context. This study contributed to one of the first predictive analyses applying AI/ML techniques to COVID-19 data using a vast sample from South Florida