Depression and anxiety disorders are prevalent in patients with heart failure. They are associated with adverse effects such as rapid disease progression, poor medication compliance, low quality of life and increased mortality rate. The current literature review aims to provide an overview of the overall rate of depression in patients who receive left ventricular assist device (LVAD) implantation and identify the psychological phases that these individuals experienced peri- and post-LVAD implantation. A PubMed search using regular and Medical Subject Headings (MeSH) keywords identified 239 articles. After applying inclusion/exclusion criteria, removal of duplicate studies, and careful review of articles, 40 studies provided relevant information on our primary end-point. These 40 studies selected include 13 paid articles with abstracts and 27 free full-text articles comprising eight prospective cohort studies, five retrospective cohort studies, six cross-sectional studies, one qualitative study, one randomized clinical trial, one systematic review, four literature reviews, and one practice guide. Our review shows that patients experienced different psychological phases after LVAD implantation. However, as the time from implantation progressed, these patients showed a significant improvement in depression, anxiety, and health-related quality of life.
This study aims to review the evidence regarding the association between peripheral artery disease (PAD) and rheumatoid arthritis (RA), as well as influential underlying factors and diagnostic options. Eligible literature was searched in PubMed published up to June 1, 2020, in English. Case studies, case series, reviews, and meta-analyses were excluded. We also excluded non-human studies and those 20 years and older. A total of 44 studies were finally incorporated in the narrative review. The results indicated that compared to controls, RA patients are more prone to PAD. Traditional risk factors, disease-characteristics, vitamin D deficiency, therapy used, and other relevant conditions have a variable effect on overall PAD progression. Studies comparing diagnostic options revealed that vascular function and morphology are connected but are still distinctive processes. In early-stage disease, there are functional alterations in the endothelium that can be controlled by anti-inflammatory medications. Ankle-Brachial Index (ABI) <0.9 might not be quite susceptible to PAD evaluation. Supplemental diagnostic tools could detect vascular disease in the preclinical stage. Most risk factors are adjustable, and the management will have a good impact on vascular health. PAD is mostly subclinical when the therapeutic options have a better impact. Diagnostic modalities should be chosen depending on the features of RA. In addition, multiple diagnostic options increase the accuracy of PAD diagnosis. Future prospective studies with larger populations at different age groups and different disease activity duration are essential to make firm conclusions and better understand the phenomenon of RA and PAD.
The mainstay of treatment for type 1 diabetes is insulin. The use of insulin for tight glycemic control is the key to preventing micro-and macrovascular complications, but it can also lead to hypoglycemic episodes. Therefore, there is a need for the introduction of a drug that can maintain glucose levels within a safe range without increasing the risk of hypoglycemia. For this reason, SGLT2 (sodium-glucose co-transporter-2) inhibitors has been a hot topic in the last couple of years. They have been proved very efficient in treating type 2 diabetes. Many trials on the safety and efficacy of SGLT2 inhibitors have been done on type 1 diabetics. Some other studies have also been done that prove their benefits in increasing arterial efficacy and reducing GFR (glomerular filtration rate). This review article discusses the benefits and risks. The literature search was performed using PubMed, and after applying the inclusion and exclusion criteria, 16 published papers were found. All relevant articles on the topic have been included. Our review has shown that the benefits of SGLT2 inhibitors outweigh their risks. Their benefits include good glycemic control, HBA1c (glycated haemoglobin) reduction, weight loss, and blood pressure improvement. Furthermore, improvement in GFR and arterial efficacy is also significant. Side effects such as UTI (urinary tract infection) and genital infection have been observed, but their incidence is low. However, DKA (diabetic ketoacidosis) and hypoglycemia are severe side effects that should be highlighted. Hypoglycemia can be prevented by strictly monitoring blood sugar levels. The patient must be educated and counseled about DKA and its symptoms. This will ensure the safety of the patient as euglycemic DKA can prove fatal if not diagnosed earlier. So, SGLT2 inhibitors can be used as an effective drug to control blood sugar levels in type 1 diabetes, especially in patients with a BMI higher than 30. It will not only achieve the treatment goals but can also decrease the morbidity and mortality of the patients. However, more studies need to be done to fully understand DKA caused by SGLT2 inhibitors.
Objective The goal of this study was to examine in-hospital complications in patients with acute ST-elevation myocardial infarction with a different renal function. Methods 351 patients were included in the study. Percutaneous coronary intervention was performed on all patients. 116 had a glomerular filtration rate < 60 ml/min/1.73 m2 (Group 1), 120 ≥ 60 ml/min/1.73 m2 and < 90 ml/min/1.73 m2 (Group 2) and 115 ≥ 90 ml/min/1.73 m2 (Group 3). Other parameters in the groups were comparable. The composite rate of acute pulmonary oedema and cardiogenic shock, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new-onset atrial fibrillation or atrial flutter, and in-hospital death were all compared among study groups. Results Mean glomerular filtration rate in Group 1 was 48.2±10.4; in Group 2, 74.7±8.7; and in Group 3, 104.1±14.6 (p < 0.001). The incidence of atrial fibrillation or atrial flutter was higher in Group 1 than in Groups 2 and 3: 12.1%, 5.8%, and 3.5%, respectively (p < 0.05). Group 3 had significantly lower rates of acute pulmonary oedema and cardiogenic shock than Groups 1 and 2: 10.3%, 5.8%, and 0.9%, respectively (p < 0.05). There was also a significant difference between groups when comparing the rate of in-hospital pneumonia: Group 1 had reasonably higher rates of in-hospital pneumonia than Group 2 and Group 3: 13.8%, 6.7%, and 4.3% (p < 0.05), respectively. The authors discovered no significant differences in additional complications: pulseless ventricular tachycardia or ventricular fibrillation occurred in 2.6%, 3.3%, and 0.9%, respectively (p > 0.05). in-hospital death was 3.4% in Group 1; 0.8% in Group 2: and 0 in Group 3, (p > 0.05). Conclusion Patients with lower glomerular filtration rate were more likely to develop in-hospital acute pulmonary oedema and cardiogenic shock, pneumonia, and new-onset atrial fibrillation or atrial flutter in ST-elevation myocardial infarction.
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