Background: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. Objectives: To determine autonomic cardiac differences between long COVID-19 patients and healthy controls and evaluate associations among symptoms, comorbidities, and laboratory findings. Methods: This single-center study included long COVID-19 patients and healthy controls. The heart rate variability (HRV), a quantitative marker of autonomic activity, was monitored for 24 h using an ambulatory electrocardiogram system. HRV indices were compared between case and control groups. Symptom frequency and inflammatory markers were evaluated. A significant statistical level of 5% (p-value 0.05) was adopted. Results: A total of 47 long COVID-19 patients were compared to 42 healthy controls. Patients averaged 43.8 (SD14.8) years old, and 60.3% were female. In total, 52.5% of patients had moderate illness. Post-exercise dyspnea was most common (71.6%), and 53.2% lacked comorbidities. CNP, D-dimer, and CRP levels were elevated (p-values of 0.0098, 0.0023, and 0.0015, respectively). The control group had greater SDNN24 and SDANNI (OR = 0.98 (0.97 to 0.99; p = 0.01)). Increased low-frequency (LF) indices in COVID-19 patients (OR = 1.002 (1.0001 to 1.004; p = 0.030)) and high-frequency (HF) indices in the control group (OR = 0.987 (0.98 to 0.995; p = 0.001)) were also associated. Conclusions: Patients with long COVID-19 had lower HF values than healthy individuals. These variations are associated with increased parasympathetic activity, which may be related to long COVID-19 symptoms and inflammatory laboratory findings.
An investigation was conducted involving 255 renal transplant recipients in the state of Goiás, Central Brazil, to determine the prevalence of hepatitis C virus (HCV), its risk factors, the genotypes involved, and the level of alanine aminotransferase (ALT) present in the patients. All serum samples were tested for anti-HCV antibodies and HCV RNA. Hepatitis C virus (HCV) is a well-known agent of liver diseases, including chronic hepatitis, cirrhosis, and hepatocellular carcinoma (Chen & Morgan 2006). Patients with chronic kidney disease are at an increased risk for acquiring HCV either because of their frequent exposure to blood from transfusions, or by exposure to HCV by nosocomial transmission, either during hemodialysis or at the time of renal transplantation. HCV infection has been established as a factor in reduced patient and graft survivals following renal transplantation (Meyers et al. 2003, Aroldi et al. 2005, Fabrizi et al. 2005, Pedroso et al. 2006, Einollahi et al. 2007.The determination of alanine aminotransferase (ALT) levels as well as HCV RNA tests have been utilized in both the diagnosis and follow-up of patients with HCV infection. The latter also plays an important role in monitoring the virological response to antiviral treatment in addition to HCV genotype determination, which is a relevant predictive parameter of the response to treatment; it is thus used for selecting therapeutic regimens (Scott & Grech 2007). This virus is classified into six genotypes (1-6), each comprising multiple subtypes (designated a, b, c, etc). These genotypes have distinct geographical distributions. Furthermore, the genotyping of HCV isolates is a useful tool for establishing the source of outbreaks in hemodialysis centers and other nosocomial settings (Zein 2000, Simmonds et al. 2005). The prevalence of HCV infection has been reported to range from 7.2% among renal transplant recipients (RTP) in Switzerland to 63.8% in Saudi Arabia (Mitwalli et al. 2006, Fehr et al. 2003. In Brazil, a continental country, epidemiological data concerning HCV infection in renal transplant patients are still rare (Corrêa et al. 2003, Giordano et al. 2003, and little is known about the genetic diversity of HCV isolates in these patients (Giordano et al. 2003, Perez et al. 2003. In this study, the prevalence of HCV infection among RTP in Central Brazil was estimated and risk factors associated with HCV infection in this population were analyzed. In addition, ALT levels and HCV genotypes were determined in these patients. PATIENTS, MATERIALS AND METHODSPatients -This study was carried out in the Santa Casa de Misericórdia in Goiânia city, the largest renal transplantation unit in the state of Goiás (GO), Central Brazil. A pilot study found a prevalence of 16% for anti-HCV. In this investigation, the sample was calculated according to the size of the population (420 RTP), on the basis of an alpha error of 5%, a power of 80%, an expected HCV prevalence of 16% and a precision of 3%. In accordance with these data, the minimum sample s...
Hypertrophic obstructive cardiomyopathy is a hereditary condition that affects myocardial contraction. In case of failure of pharmacological treatment, alternative approaches might be used that include surgical myectomy, percutaneous transluminal septal myocardial ablation, and radiofrequency ablation. In respect of long-term advantages, surgical septal myectomy remains the therapy of choice for symptomatic hypertrophic obstructive cardiomyopathy. Alcohol septal ablation has been considered an alternative to surgical myectomy, which confers the benefits of a shorter hospital stay, less discomfort, and fewer complications. However, only expert operators should perform it on carefully chosen patients. Further, radiofrequency septal ablation reduces the left ventricular outflow tract gradient and improves the NYHA functional class of patients with hypertrophic obstructive cardiomyopathy, despite complications like cardiac tamponade and atrioventricular block. Further research with a larger sample size is required to compare the radiofrequency approach with established invasive treatment methods for hypertrophic obstructive cardiomyopathy. Septal myectomy has low morbidity and mortality rates, making it the preferred procedure; however, the efficacy and morbidity remain debatable. Advances in invasive techniques, including percutaneous septal radiofrequency ablation and transcatheter myotomy, have provided alternative approaches for reducing left ventricular outflow tract (LVOT) obstruction in patients who are not candidates for traditional surgical septal myectomy. Candidates for alcohol and radiofrequency septal ablation include patients with symptomatic hypertrophic obstructive cardiomyopathy, older adults, and those with multiple comorbidities.
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