ImportanceMost epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries.ObjectiveTo examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development.Design, Setting, and ParticipantsMultinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years.Main Outcomes and MeasuresHF cause, HF medication use, hospitalization, and death.ResultsMean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies.Conclusions and RelevanceThis study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.
The article aims to conduct a 3D analysis of links and levels of the intraorgan venous system of the human kidney and build a model of its levels and spatial hierarchy. 46 corrosive preparations of the renal venous system were produced. The preparations were subjected to 3D scanning. Using Mimics-8.1, options and types of fusion of intraorgan venous vessels of the kidneys were studied. The 3D stereo-anatomical analysis of the intraorgan venous system of the kidneys showed that there are upper polar, lower polar, central, ventral and dorsal veins, depending on the options of fusion of the renal veins. 25.4% of the second order vessels are ventral and dorsal. The intraorgan venous bed of the kidney is not represented by the pole veins. 32.4% of the second order vessels are upper pole and lower pole veins. The 3D analysis of the intraorgan venous system of the human kidney revealed new links in the hierarchy of the structure of the venous system of the kidney which differs from the scheme presented by A. Kugelgen (1928) where there were four orders. The new hierarchy differs from the scheme presented in the International Anatomical Nomenclature (2003). The authors presented a new concept of spatial and level organization of the venous bed of the human kidney. The range of individual variability of the angioarchitecture of the venous system of the human kidney, namely the presence of venous vessel links and levels, depends on the options of formation of the renal vein in the kidney gate, and types of fusion of the intraorgan venous system of the kidney.
INTRODUCTION: Ventricular tachycardia (VT) is a life-threatening event. The role of the medical rescue team is to diagnose this disorder on the basis of resuscitation guidelines and general recommendations concerning ECG diagnoses. Patients with ventricular tachycardia, as a result of cerebral hypoxia, may react with aggression. In such situations, taking one's medical history, conducting a physical examination or attempting emergency rescue operations may become difficult, or even impossible. OBJECTIVE: The objective of the paper is to demonstrate the issue of unintentional aggression that may occur in patients with ventricular tachycardia (VT) with a high heart rate and a short episode of cardiac arrest (CA), and the impact of such a disorder on attempted medical rescue operations. MATERIAL AND METHODS: The analysis of the case study was performed on the basis of medical documentation, i.e. an emergency dispatch order and an emergency medical services form. CASE DESCRIPTION: A medical emergency unit stationed at one of the substations in Łódź Province, 27 km away from a multidisciplinary hospital, received a call from a medical dispatcher. The person calling emergency services requested the urgent arrival of an ambulance for her husband, who had suddenly passed out and was now lying on the kitchen floor showing no signs of life. In the course of the ambulance's arrival at the location, the patient's wife urged the ambulance to arrive soon, on account of her husband's aggressive behaviour. CONCLUSIONS: Cardiac dysrhythmia and particularly ventricular tachycardia (VT) may constitute a serious health issue for the patient. The clinical picture may also vary across patients. An analysis of the case study demonstrates that medical personnel must be prepared to handle unconventional scenarios. The article shows that the procedure of cardioversion may be the only right choice when handling a patient with an unstable tachycardia.
The aim of this work was to study the results of a new method of gastroplication in patients with overweight and obesity.Materials and methods. Presented the results of applying the original laparoscopic gastroplication technique in 15 patients with morbid obesity at the BSMU Clinic.Results. The observation time was from 4 months up to 18 months. A stable effect was achieved in 12 patients (80%), who decreased in overweight from 20 to 52% and a regression of comorbid pathology. Further studies will allow to detail the indications and selection of patients and determine the place of the proposed method among restrictive operations to reduce weight.
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