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Factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit

Sundar VV, Sehu Allavudin SF, Easaw MEPM

Clin Nutr ESPEN, 2021 06;43:353-359.
PMID: 34024540 DOI: 10.1016/j.clnesp.2021.03.024

BACKGROUND & AIMS: Inadequate nutrition delivery in critically ill children has shown associated with poor clinical outcomes. Therefore, identifying barriers to deliver adequate nutrition is vital. The aim of this study was to identify factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit (PICU).
METHODS: This single-centre prospective study, involved children aged from birth to 3 years old, admitted to PICU longer than 72 hours. They received either enteral nutrition (EN) or combination of EN and partial parenteral nutrition (PPN). Clinical and nutrition delivery characteristics were recorded from admission until transferred out of PICU. Multiple regression analysis at significant level p heart disease in PICU. Strategies to improve the nutrition delivery in this group of patients should be outlined and implemented by the dietitians along with multidisciplinary team.

Matched MeSH terms: Heart Diseases*
Fulltext Growth of Hepatocellular Carcinoma into the Right Atrium with Associated Pulmonary Tumour Emboli

Amran, A.R., Ranganathan, S.

International Medical Journal Malaysia, 2006;5(1):1-5.
MyJurnal

Hepatocellular carcinoma (HCC) presenting with right atrial metastases and pulmonary tumour embolism is rare . Intracavitary cardiac metastasis is uncommon and metastasis to the right atrium is even less common. The majority of such cases are believed to be due to advanced HCC such as Stage III or IV, in which the progression rate is high, and in infiltrative HCC it tends to be associated with vascular invasion. The diagnosis of pulmonary intravascular tumour emboli is difficult to establish both clinically and with conventional radiographic studies. We report a case hepatocellular carcinoma associated with tumour thrombus in the inferior vena cava (IVC), right atrium and pulmonary tumour embolism detected with multidetector helical computerized tomography (MDHCT).

Matched MeSH terms: Heart Atria; Heart Neoplasms
Paroxysmal atrial fibrillation prediction method with shorter HRV sequences

Boon KH, Khalil-Hani M, Malarvili MB, Sia CW

Comput Methods Programs Biomed, 2016 Oct;134:187-96.
PMID: 27480743 DOI: 10.1016/j.cmpb.2016.07.016

This paper proposes a method that predicts the onset of paroxysmal atrial fibrillation (PAF), using heart rate variability (HRV) segments that are shorter than those applied in existing methods, while maintaining good prediction accuracy. PAF is a common cardiac arrhythmia that increases the health risk of a patient, and the development of an accurate predictor of the onset of PAF is clinical important because it increases the possibility to stabilize (electrically) and prevent the onset of atrial arrhythmias with different pacing techniques. We investigate the effect of HRV features extracted from different lengths of HRV segments prior to PAF onset with the proposed PAF prediction method. The pre-processing stage of the predictor includes QRS detection, HRV quantification and ectopic beat correction. Time-domain, frequency-domain, non-linear and bispectrum features are then extracted from the quantified HRV. In the feature selection, the HRV feature set and classifier parameters are optimized simultaneously using an optimization procedure based on genetic algorithm (GA). Both full feature set and statistically significant feature subset are optimized by GA respectively. For the statistically significant feature subset, Mann-Whitney U test is used to filter non-statistical significance features that cannot pass the statistical test at 20% significant level. The final stage of our predictor is the classifier that is based on support vector machine (SVM). A 10-fold cross-validation is applied in performance evaluation, and the proposed method achieves 79.3% prediction accuracy using 15-minutes HRV segment. This accuracy is comparable to that achieved by existing methods that use 30-minutes HRV segments, most of which achieves accuracy of around 80%. More importantly, our method significantly outperforms those that applied segments shorter than 30 minutes.

Matched MeSH terms: Heart Rate*
A brief review of the diabetes mellitus, heart disease and blood pressure studies

Loncin H

Med J Malaya, 1965 Jun;19(4):321-3.
PMID: 4220862
Matched MeSH terms: Heart Diseases/epidemiology*
Intracardiac leiomyomatosis

Bewersdorf T, Loch A

Eur Heart J, 2018 11 01;39(41):3750.
PMID: 30052855 DOI: 10.1093/eurheartj/ehy415
Matched MeSH terms: Heart Neoplasms*
Fulltext A Rare Presentation of Anterior Mediastinal Teratoma Mimicking Valvular Heart Disease with A Systolic Murmur

Lip HTC, Huei TJ, Wahid AA, Vendargon SJ

Eurasian J Med, 2018 Jun;50(2):134-136.
PMID: 30002584 DOI: 10.5152/eurasianjmed.2018.17388

Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.

Matched MeSH terms: Heart Murmurs; Heart Valve Diseases
Massive pericardial effusion - An uncommon initial presentation of systemic lupus erythematosus (SLE)

Cheo SW, Low QJ

Med J Malaysia, 2019 Oct;74(5):439-440.
PMID: 31649224

Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.

Matched MeSH terms: Heart Block; Heart Failure
Computer-aided diagnosis of congestive heart failure using ECG signals - A review

Jahmunah V, Oh SL, Wei JKE, Ciaccio EJ, Chua K, San TR, et al.

Phys Med, 2019 Jun;62:95-104.
PMID: 31153403 DOI: 10.1016/j.ejmp.2019.05.004

The heart muscle pumps blood to vital organs, which is indispensable for human life. Congestive heart failure (CHF) is characterized by the inability of the heart to pump blood adequately throughout the body without an increase in intracardiac pressure. The symptoms include lung and peripheral congestion, leading to breathing difficulty and swollen limbs, dizziness from reduced delivery of blood to the brain, as well as arrhythmia. Coronary artery disease, myocardial infarction, and medical co-morbidities such as kidney disease, diabetes, and high blood pressure all take a toll on the heart and can impair myocardial function. CHF prevalence is growing worldwide. It afflicts millions of people globally, and is a leading cause of death. Hence, proper diagnosis, monitoring and management are imperative. The importance of an objective CHF diagnostic tool cannot be overemphasized. Standard diagnostic tests for CHF include chest X-ray, magnetic resonance imaging (MRI), nuclear imaging, echocardiography, and invasive angiography. However, these methods are costly, time-consuming, and they can be operator-dependent. Electrocardiography (ECG) is inexpensive and widely accessible, but ECG changes are typically not specific for CHF diagnosis. A properly designed computer-aided detection (CAD) system for CHF, based on the ECG, would potentially reduce subjectivity and provide quantitative assessment for informed decision-making. Herein, we review existing CAD for automatic CHF diagnosis, and highlight the development of an ECG-based CAD diagnostic system that employs deep learning algorithms to automatically detect CHF.

Matched MeSH terms: Heart Failure/diagnosis*
ß-blockers in congestive heart failure

Teh BT, Wan Azman WA, Thuraisingham S, Choy AM, Tan KH, Jesudason P, et al.

JUMMEC, 1999;4:26-33.

Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.

Matched MeSH terms: Heart; Heart Failure
Determination of cardiac disease biomarker by plasmonic sandwich ELISA

Wei W, Tang Y, He H, Gopinath SCB, Wang L

Biotechnol Appl Biochem, 2022 Feb;69(1):160-165.
PMID: 33369762 DOI: 10.1002/bab.2092

Acute myocardial infarction (AMI) is the heart attack happening when the blood flow is terminated to the heart muscles. C-reactive protein (CRP) level is raising significantly in AMI patients after the onset of symptom; also, temporal variations of CRP in plasma of AMI patient have also been found. Quantifying the concentration of CRP helps to identify the condition associated with AMI. Plasmonic enzyme-linked immunosorbent assay (ELISA) was utilized here to identify CRP by the sandwich of aptamer and antibody. Bare-eye CRP detection was achieved by plasmonic ELISA through the aggregation (blue color) of gold nanoparticle in the presence of CRP, whereas in the absence of CRP, it retains its red color (dispersion). Depending on the catalase presence on the ELISA surface, hydrogen peroxide (H2 O2 ) controls gold growth and differentiates with color changes. To achieve the lowest detection limit of CRP, H2 O2 (200 µM), gold seed (0.2 µM), and streptavidin-catalase (1:500) were found optimal. The detection limit was reached at 0.25 µg/mL, whereas it was 0.5 µg/mL in the CRP-spiked serum. This method of detection system is easier to detect the levels of CRP and helps diagnosing AMI.

Matched MeSH terms: Heart Diseases*
Quantifying Regional and Health Care Variations to Identify Ways to Improve Hemodialysis Service Quality and Survival Outcomes

Jamal A, Babazono A, Li Y, Yoshida S, Fujita T, Kim SA

Am J Med Qual, 2021 5 20;36(5):345-354.
PMID: 34010165 DOI: 10.1097/01.JMQ.0000735484.44163.ce

The authors examined variations in hemodialysis care and quantified the effect of these variations on all-cause mortality. Insurance claims data from April 1, 2017 to March 30, 2018 were reviewed. In total, 2895 hospital patients were identified, among whom 398 died from various causes. Controlling effects of the facility and secondary medical care areas, all-cause mortality was associated with older age, heart failure, malignancy, cerebral stroke, severe comorbidity, and the first and ninth centile of physician density. Multilevel analyses indicated a significant variation at facility level (σ22 0.27, 95% confidence interval: 0.09-0.49). Inclusion of all covariates in the final model significantly reduced facility-level variance. Physician density emerged as an important factor affecting survival outcome; thus, a review of workforce and resource allocation policies is needed. Better clinical management and standardized work processes are necessary to attenuate differences in hospital practice patterns.

Matched MeSH terms: Heart Failure*
Fulltext Multimodality registration of two-dimensional echocardiography and cardiac CT for mitral valve diagnosis and surgical planning

Khalil A, Faisal A, Ng SC, Liew YM, Lai KW

J Med Imaging (Bellingham), 2017 Jul;4(3):037001.
PMID: 28840172 DOI: 10.1117/1.JMI.4.3.037001

A registration method to fuse two-dimensional (2-D) echocardiography images with cardiac computed tomography (CT) volume is presented. The method consists of two major procedures: temporal and spatial registrations. In temporal registration, the echocardiography frames at similar cardiac phases as the CT volume were interpolated based on electrocardiogram signal information, and the noise of the echocardiography image was reduced using the speckle reducing anisotropic diffusion technique. For spatial registration, an intensity-based normalized mutual information method was applied with a pattern search optimization algorithm to produce an interpolated cardiac CT image. The proposed registration framework does not require optical tracking information. Dice coefficient and Hausdorff distance for the left atrium assessments were [Formula: see text] and [Formula: see text], respectively; for left ventricle, they were [Formula: see text] and [Formula: see text], respectively. There was no significant difference in the mitral valve annulus diameter measurement between the manually and automatically registered CT images. The transformation parameters showed small deviations ([Formula: see text] deviation in translation and [Formula: see text] for rotation) between manual and automatic registrations. The proposed method aids the physician in diagnosing mitral valve disease as well as provides surgical guidance during the treatment procedure.

Matched MeSH terms: Heart Atria; Heart Ventricles
Fulltext Socio demographic profiles of rheumatic heart disease (RHD) patients in Sabah

Narwani Hussin, Wong, Mabelle, Liew, Houng Bang, Liau, Siow Yen

Int J Public Health Res, 2016;6(2):736-740.
MyJurnal

Introduction: Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) II, Kota Kinabalu, Sabah.
Methods: A secondary data review of all patients registered under the RHD registry in HQE II for one- year starting from July 2013 to June 2014.
Results: 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary
education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km.
Conclusions: Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program. .

Matched MeSH terms: Rheumatic Heart Disease*
Systematic review of economic burden of heart failure

Shafie AA, Tan YP, Ng CH

Heart Fail Rev, 2018 01;23(1):131-145.
PMID: 29124528 DOI: 10.1007/s10741-017-9661-0

The aim of this study is to perform a systematic review of the costing methodological approaches adopted by published cost-of-illness (COI) studies. A systematic review was performed to identify cost-of-illness studies of heart failure published between January 2003 and September 2015 via computerized databases such as Pubmed, Wiley Online, Science Direct, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Costs reported in the original studies were converted to 2014 international dollars (Int$). Thirty five out of 4972 studies met the inclusion criteria. Nineteen out of the 35 studies reported the costs as annual cost per patient, ranging from Int$ 908.00 to Int$ 84,434.00, while nine studies reported costs as per hospitalization, ranging from Int$ 3780.00 to Int$ 34,233.00. Cost of heart failure increased as condition of heart failure worsened from New York Heart Association (NYHA) class I to NYHA class IV. Hospitalization cost was found to be the main cost driver to the total health care cost. The annual cost of heart failure ranges from Int$ 908 to Int$ 40,971 per patient. The reported cost estimates were inconsistent across the COI studies, mainly due to the variation in term of methodological approaches such as disease definition, epidemiological approach of study, study perspective, cost disaggregation, estimation of resource utilization, valuation of unit cost components, and data sources used. Such variation will affect the reliability, consistency, validity, and relevance of the cost estimates across studies.

Matched MeSH terms: Heart Failure/economics*
A comparison of low and high dose of moderate intensity aerobic exercise on heart rate recovery of the sedentary adults: a pragmatic randomized controlled trial

Jaafar Z, Lim YZ

J Sports Med Phys Fitness, 2023 Feb;63(2):310-318.
PMID: 35620954 DOI: 10.23736/S0022-4707.22.13958-7

BACKGROUND: Heart rate recovery (HRR) has been used as a prognostication marker of health. A slower drop in HRR is linked to a higher risk of cardiovascular diseases and all-cause mortality. Since aerobic exercise has been shown to have favorable effects on HRR, we aimed to compare the effects of two different aerobic exercise doses on HRR among a sedentary adult population.
METHODS: A pragmatic randomised controlled trial was conducted on 29 healthy sedentary adults (seven males and 22 females) in a 12-week exercise program. They were randomly assigned to group A (75 min/week, N.=15) or group B (150 min/week, N.=14) of moderate intensity aerobic exercise groups. HRR at 1-minute (HRR1), HRR at 2-minute (HRR2), and peak oxygen uptake (VO2peak) were measured pre- and post-intervention.
RESULTS: The improvements of HRR1 and HRR2 were seen in both groups but was only significant (P<0.05) for group A with HRR1, -4.07 bpm (post 24.47±6.42 - pre 20.40±5.51, P=0.018) and HHR2, -3.93 bpm (post 43.40±13.61 - pre 39.47±10.68, P=0.046). Group B showed increment of HRR1, -1.14 bpm (post 21.14±5.35 - pre 20.00±6.30, P=0.286) and HRR2, -2.5 bpm, (post 39.36±8.01 - pre 36.86±9.57, P=0.221). Improvement of the VO2peak was only significant in group B with an increment of 1.52±2.61 (P=0.049).
CONCLUSIONS: In conclusion, our study suggests that improvements in heart rate recovery (HRR1 and HRR2) among sedentary healthy adults can be achieved by engaging in moderate intensity exercise at a dose lower than the current recommended guidelines. The lower dose seems to be more attainable and may encourage exercise compliance. Future studies should further explore the effects of different exercise volumes on HRR in a larger sample size and also by controlling for BMI or gender.

Matched MeSH terms: Heart Rate/physiology
Fulltext Development and validation of algorithms for heart failure patient care: a Delphi study

Gopal CP, Ranga A, Joseph KL, Tangiisuran B

Singapore Med J, 2015 Apr;56(4):217-23.
PMID: 25532514 DOI: 10.11622/smedj.2014190

Although heart failure (HF) management is available at primary and secondary care facilities in Malaysia, the optimisation of drug therapy is still suboptimal. Although pharmacists can help bridge the gap in optimising HF therapy, pharmacists in Malaysia currently do not manage and titrate HF pharmacotherapy. The aim of this study was to develop treatment algorithms and monitoring protocols for angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and spironolactone based on extensive literature review for validation and utilization by pharmacists involved in HF management.

Matched MeSH terms: Heart Failure/therapy*
Fulltext Cardiovascular malformations in Malaysian neonates with Down's syndrome

Hoe TS, Chan KC, Boo NY

Singapore Med J, 1990 Oct;31(5):474-6.
PMID: 2148028

A prospective study was done to determine the incidence of cardiovascular malformations in neonates with Down's syndrome. 17/34 (50%) of the babies with Down's syndrome born at the Maternity Hospital, Kuala Lumpur, Malaysia had congenital heart defects. These included 7 cases of ventricular septal defect (VSD), 3 cases of patent ductus arteriosus (PDA), 2 cases of atrio-ventricular canal defect, 2 cases of ventricular septal defect with patent ductus arteriosus, 1 case of hypertrophic cardiomyopathy, 1 case of hypertrophic obstructive cardiomyopathy and 1 case of complex cyanotic heart. Only 8/17 (47%) of these babies had any clinical signs suggesting underlying cardiac defects. In view of the common occurrence of cardiac anomalies, it is recommended that echocardiographic screening should be carried out on all neonates with Down's syndrome.

Matched MeSH terms: Heart Defects, Congenital/complications*
Fulltext Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis

Hudson J, Cruickshank M, Quinton R, Aucott L, Aceves-Martins M, Gillies K, et al.

Lancet Healthy Longev, 2022 Jun;3(6):e381-e393.
PMID: 35711614 DOI: 10.1016/S2666-7568(22)00096-4

BACKGROUND: Testosterone is the standard treatment for male hypogonadism, but there is uncertainty about its cardiovascular safety due to inconsistent findings. We aimed to provide the most extensive individual participant dataset (IPD) of testosterone trials available, to analyse subtypes of all cardiovascular events observed during treatment, and to investigate the effect of incorporating data from trials that did not provide IPD.
METHODS: We did a systematic review and meta-analysis of randomised controlled trials including IPD. We searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Epub Ahead of Print, Embase, Science Citation Index, the Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and Database of Abstracts of Review of Effects for literature from 1992 onwards (date of search, Aug 27, 2018). The following inclusion criteria were applied: (1) men aged 18 years and older with a screening testosterone concentration of 12 nmol/L (350 ng/dL) or less; (2) the intervention of interest was treatment with any testosterone formulation, dose frequency, and route of administration, for a minimum duration of 3 months; (3) a comparator of placebo treatment; and (4) studies assessing the pre-specified primary or secondary outcomes of interest. Details of study design, interventions, participants, and outcome measures were extracted from published articles and anonymised IPD was requested from investigators of all identified trials. Primary outcomes were mortality, cardiovascular, and cerebrovascular events at any time during follow-up. The risk of bias was assessed using the Cochrane Risk of Bias tool. We did a one-stage meta-analysis using IPD, and a two-stage meta-analysis integrating IPD with data from studies not providing IPD. The study is registered with PROSPERO, CRD42018111005.
FINDINGS: 9871 citations were identified through database searches and after exclusion of duplicates and of irrelevant citations, 225 study reports were retrieved for full-text screening. 116 studies were subsequently excluded for not meeting the inclusion criteria in terms of study design and characteristics of intervention, and 35 primary studies (5601 participants, mean age 65 years, [SD 11]) reported in 109 peer-reviewed publications were deemed suitable for inclusion. Of these, 17 studies (49%) provided IPD (3431 participants, mean duration 9·5 months) from nine different countries while 18 did not provide IPD data. Risk of bias was judged to be low in most IPD studies (71%). Fewer deaths occurred with testosterone treatment (six [0·4%] of 1621) than placebo (12 [0·8%] of 1537) without significant differences between groups (odds ratio [OR] 0·46 [95% CI 0·17-1·24]; p=0·13). Cardiovascular risk was similar during testosterone treatment (120 [7·5%] of 1601 events) and placebo treatment (110 [7·2%] of 1519 events; OR 1·07 [95% CI 0·81-1·42]; p=0·62). Frequently occurring cardiovascular events included arrhythmia (52 of 166 vs 47 of 176), coronary heart disease (33 of 166 vs 33 of 176), heart failure (22 of 166 vs 28 of 176), and myocardial infarction (10 of 166 vs 16 of 176). Overall, patient age (interaction 0·97 [99% CI 0·92-1·03]; p=0·17), baseline testosterone (interaction 0·97 [0·82-1·15]; p=0·69), smoking status (interaction 1·68 [0·41-6·88]; p=0.35), or diabetes status (interaction 2·08 [0·89-4·82; p=0·025) were not associated with cardiovascular risk.
INTERPRETATION: We found no evidence that testosterone increased short-term to medium-term cardiovascular risks in men with hypogonadism, but there is a paucity of data evaluating its long-term safety. Long-term data are needed to fully evaluate the safety of testosterone.
FUNDING: National Institute for Health Research Health Technology Assessment Programme.

Matched MeSH terms: Heart Failure*
Tacrolimus Therapy in Adult Heart Transplant Recipients: Evaluation of a Bayesian Forecasting Software

Kirubakaran R, Stocker SL, Carlos L, Day RO, Carland JE

Ther Drug Monit, 2021 Dec 01;43(6):736-746.
PMID: 34126624 DOI: 10.1097/FTD.0000000000000909

BACKGROUND: Therapeutic drug monitoring is recommended to guide tacrolimus dosing because of its narrow therapeutic window and considerable pharmacokinetic variability. This study assessed tacrolimus dosing and monitoring practices in heart transplant recipients and evaluated the predictive performance of a Bayesian forecasting software using a renal transplant-derived tacrolimus model to predict tacrolimus concentrations.
METHODS: A retrospective audit of heart transplant recipients (n = 87) treated with tacrolimus was performed. Relevant data were collected from the time of transplant to discharge. The concordance of tacrolimus dosing and monitoring according to hospital guidelines was assessed. The observed and software-predicted tacrolimus concentrations (n = 931) were compared for the first 3 weeks of oral immediate-release tacrolimus (Prograf) therapy, and the predictive performance (bias and imprecision) of the software was evaluated.
RESULTS: The majority (96%) of initial oral tacrolimus doses were guideline concordant. Most initial intravenous doses (93%) were lower than the guideline recommendations. Overall, 36% of initial tacrolimus doses were administered to transplant recipients with an estimated glomerular filtration rate of <60 mL/min/1.73 m despite recommendations to delay the commencement of therapy. Of the tacrolimus concentrations collected during oral therapy (n = 1498), 25% were trough concentrations obtained at steady-state. The software displayed acceptable predictions of tacrolimus concentration from day 12 (bias: -6%; 95%confidence interval, -11.8 to 2.5; imprecision: 16%; 95% confidence interval, 8.7-24.3) of therapy.
CONCLUSIONS: Tacrolimus dosing and monitoring were discordant with the guidelines. The Bayesian forecasting software was suitable for guiding tacrolimus dosing after 11 days of therapy in heart transplant recipients. Understanding the factors contributing to the variability in tacrolimus pharmacokinetics immediately after transplant may help improve software predictions.

Matched MeSH terms: Heart Transplantation*
Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review

Esmailiyan M, Amerizadeh A, Vahdat S, Ghodsi M, Doewes RI, Sundram Y

Curr Probl Cardiol, 2023 Mar;48(3):101034.
PMID: 34718034 DOI: 10.1016/j.cpcardiol.2021.101034

High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.

Matched MeSH terms: Heart Failure*

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