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Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Equine Veterinary Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction/background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The AF Atrial Fibrillation Registry, which commenced in June 2023, was designed to provide clinical epidemiological data on patients with AF in the country., Objective(s): The objective is to describe the rationale, design, and early findings from the registry., Materials/methods: This is a prospective clinical registry of adult patients aged 18 years and above with AF., Results: The registry so far included 276 patients who met the eligibility criteria. There were 146(52.8%) males (mean age-63.3(14.13) years) and 130 (47.1%) females (mean age-59.3(17.58) years) Cardiovascular risk profile of the patients with AF was cigarette smoking (current/previous 2(38 %), hypertension 203(74%), diabetes 28(10.3%), and family history of CVD 56(20.6%). The median CHADVASC score is 3(IQR - 2,4). Rate control was the most frequent management strategy. Eighty-seven (87) have completed 6 months of follow-up, 10(11%) were re-hospitalized, and 9(10.3%) died., Conclusions: Compared to developed countries, our patients with AF are relatively young and have lower rates of diabetes mellitus but higher rates of hypertension. Rate control is the main strategy used for managing AF. Mortality is high at one year but lags behind re-hospitalization. This may provide an opportunity for intervention., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

A 3-year-old neutered male standard poodle mix dog was presented because of acute onset vomiting, increased respiratory effort, hyporexia, and progressive lethargy. On physical examination, intermittent tachycardia, tachypnea with mildly increased respiratory effort, and bilateral ventral muffled lung sounds were noted. Thoracic and abdominal computed tomography with contrast revealed a peritoneal pericardial diaphragmatic hernia (PPDH) with herniation of the liver and gallbladder, moderate abdominal lymphadenopathy, and mild pleural effusion. The dog underwent an emergency laparotomy and median sternotomy. Right ventral PPDH with a herniated, necrosed, and nonviable quadrate liver lobe and gallbladder; 2 suspected right ventricular (RV) aneurysms; and generalized mesenteric and portal lymphadenopathy were present. The affected liver lobe and gallbladder were removed; suspected aneurysms were managed by placing 2 purse-string sutures around the lesions and anchoring a pericardial flap over the aneurysms. The dog developed a ventricular arrhythmia postoperatively. Due to the arrhythmia and intraoperative findings of suspected aneurysms, echocardiography was performed and revealed focal RV systolic dysfunction, left ventricular systolic dysfunction, mild left ventricular dilation, and a hyperechoic area on the RV free wall, consistent with the purse string. An angiotensin-convertingenzyme (ACE) inhibitor was prescribed for left ventricular dilation. The dog was discharged 4 d postoperatively and was doing well 12 mo postoperatively. To our knowledge, this is the first report of a PPDH and suspected concurrent RV wall aneurysm in a dog successfully treated with a purse string and pericardial flap. Key clinical message: An RV aneurysm is extremely rare yet can be life-threatening in small animals. Early detection and treatment may minimize the risk of aneurysm rupture and sudden death., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Patients with anterior ST elevation myocardial infarction (STEMI) are vulnerable to life-threatening ventricular arrhythmia and arrhythmic death. This study aimed to investigate the predictive value of Tpeak-to-Tend (TpTe) and TpTe/QT ratio in patients with anterior STEMI on admission for the occurrence of in-hospital life-threatening ventricular arrhythmias and arrhythmic death. This observational cross-sectional research was performed on patients with anterior STEMI who showed up within 12 hours of the beginning of symptoms and received the initial percutaneous coronary intervention (pPCI). The primary study endpoints included the assessment of sustained ventricular arrhythmias and all-cause/arrhythmic deaths throughout the hospitalization. Data collection involved clinical history, vital signs monitoring, ECG measurements, LVEF evaluation, and performance of pPCI procedures. The studied patients had a mean age of 53 ± 11 years. Patients with arrhythmic events displayed a significant rise in QT dispersion, TpTe, TpTe/QT, and arrhythmic death rates (P < 0.05). A multivariate logistic regression examination revealed that HR (with an OR of 1.037 and a 95% CI of 1.004 to 1.071, P = 0.027), TpTe (with an OR of 1.025 and a 95% CI of 1.004 to 1.047, P = 0.022), and TpTe/QT (with an OR of 5.464 and a 95% CI of 2.027 to 14.726, P = 0.001) were found to be significant predictors of arrhythmic events or mortality. In patients with anterior STEMI, TpTe and TpTe/QT ratio are significant predictors of in-hospital VA and arrhythmic death. Higher TpTe and TpTe/QT values are linked to a higher risk of these occurrences. [ABSTRACT FROM AUTHOR]

Background: Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers. Methods: Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex. Results: A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e’ ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival. Conclusions: Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care. Résumé: Contexte: La bicuspide valvulaire aortique (BVA) est une anomalie cardiaque congénitale fréquente. Les patients atteints d’une BVA présentent des risques de complications à long terme, comme la sténose valvulaire ou la régurgitation valvulaire. Cette étude visait 1) à évaluer les différences entre les sexes en ce qui concerne les biomarqueurs sanguins et les biomarqueurs à l’imagerie; et 2) à décrire la valeur pronostique à long terme des biomarqueurs sanguins et échocardiographiques. Méthodologie: Des patients de 2 études de cohortes observationnelles prospectives ont été inclus dans l’analyse. Des échantillons de sang veineux ont été prélevés, et des échocardiographies transthoraciques, y compris le suivi des marqueurs acoustiques, ont été effectuées. Les biomarqueurs sanguins analysés étaient les suivants : indice de distribution des globules rouges (IDR), créatinine, protéine C-réactive (CRP), troponine T, propeptide natriurétique de type B N-terminal (NT-proBNP) et facteur de croissance transformant β (TGF-β). Les différences entre les sexes ont été analysées au départ. Les liens entre les biomarqueurs et la survie sans arythmie et sans intervention ont été déterminés par la régression de Cox, avec correction en fonction de l’âge et du sexe. Résultats: Cent quatre-vingt-deux patients présentant une BVA étaient inclus (âge médian de 34 [écart interquartile : 23-46] ans, 55,5 % hommes). La CRP, la NT-proBNP et l’IDR étaient plus élevées chez les femmes, alors que la créatinine, la troponine T et le TGF-β étaient plus élevés chez les hommes. Après une période de suivi médiane de 6,9 (écart interquartile : 6,5-9,9) ans, les taux de survie sans arythmie et sans intervention étaient respectivement de 81,0 % et de 73,1 %. La NT-proBNP a été associée à la survie sans arythmie (rapport des risques instantanés [RRI] : 1,94, p = 0,005) et à la survie sans intervention (RRI : 2,06, p = 0,002). À l’échocardiographie, des valeurs élevées pour la taille de l’oreillette gauche, le diamètre télédiastolique du ventricule gauche (VG), l’indice de masse du VG et le rapport E/e’ étaient associées à un faible taux de survie sans arythmie, alors que des valeurs élevées pour la taille de l’oreillette gauche, l’indice de masse du VG, la vitesse maximale aortique et la régurgitation aortique étaient associées à un faible taux de survie sans intervention. Conclusions: Les biomarqueurs sanguins variaient en fonction du sexe des personnes présentant une BVA. Outre les paramètres systoliques du VG, la fonction VG diastolique et la NT-proBNP devraient être davantage utilisées comme marqueurs pronostiques en soins cliniques.

Copyright of Canadian Journal of Art Therapy is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients., Methods: We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates., Results: A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death., Conclusions: ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications., (© 2024 The Authors.)

Le tocilizumab (TCZ) a démontré son efficacité chez les patients atteints de sclérodermie systémique avec pneumopathie interstitielle (SSc-PI), avec un bénéfice potentiel également sur la fibrose cutanée. Nous avons évalué la sécurité et l'efficacité multidomaines du TCZ dans un contexte de soins courants à partir d'une cohorte multicentrique franco-italienne. Les patients atteints de SSc et traités par TCZ ont été évalués rétrospectivement 12 mois avant l'introduction du TCZ, au moment de l'initiation du traitement, puis à 12 et 24 mois après son introduction. Les paramètres suivants ont été enregistrés : score cutané modifié de Rodnan (mRSS), épreuves fonctionnelles respiratoires (EFP), DAS28-CRP, niveaux de troponine et de NT-proBNP, fraction d'éjection (FE) et Health Assessment Questionnaire (HAQ). Les facteurs prédictifs de l'arrêt du TCZ pour inefficacité ont été identifiés. Au total, 197 patients atteints de SSc traités par TCZ (88 % de femmes), avec un âge médian de 57(46–69) ans et une durée médiane de la maladie de 9 (4–15) ans, ont été inclus (Tableau 1). Les caractéristiques initiales, les thérapies concomitantes et les raisons de l'introduction du TCZ sont résumées dans le Tableau 1. Parmi les patients avec SSc-PI, dans les 12 mois précédant l'introduction du TCZ, le %CVF a montré une diminution significative (p = 0,003), avec 44 % des patients présentant une diminution du %CVF ≥ 5. Après l'introduction du TCZ, une stabilisation du %CVF a été observée à 12 mois (p = 0,07), avec une diminution à 22 % (p = 0,001) du nombre de progresseurs. Une stabilisation du %CVF a également été observée à 24 mois (p = 0,005). Le nombre de progresseurs entre le 12e et le 24e mois était de 19 %, p = 0,680. Chez les patients atteints de dcSSc, une réduction significative du mRSS a été observée à la fois au 12e et au 24e mois après l'introduction du TCZ. Par ailleurs, le % de patients avec ulcères digitaux est resté stable au moment de l'inclusion par rapport aux 12 mois précédant (p = 0,99), puis a diminué au 12e mois (p = 0,026) et au 24e mois (p = 0,001). Chez les patients atteints d'arthrite, le DAS28-CRP a montré une diminution significative aux 12e et 24e mois, associée à une diminution du NAD et du NAG. Chez les patients avec atteinte myocardique, les niveaux de troponine ont diminué au fil du temps, accompagnés d'une stabilisation des niveaux de NT-proBNP. Une stabilisation a également été observée dans la FE (%) et dans le % de patients nécessitant un traitement pour arythmie. Les événements indésirables les plus fréquents étaient des infections (22,8 %). Le TCZ a été suspendu chez 63 patients (32 %) après une durée médiane de 8 (4–22) mois, la principale raison étant l'inefficacité (41 %). Cinquante-sept (29 %) des patients étaient sous TCZ en monothérapie. Lors de l'analyse multivariée, la présence de HTAP (5,313 [1,431–19,724]) et une élévation de la CRP (0,108 [0,023–0,505]) ont été associées à l'arrêt du TCZ pour inefficacité. Aucune différence n'a été observée dans le taux d'inefficacité ni dans les effets secondaires lors de la comparaison entre la monothérapie et la thérapie combinée (10 % contre 14,7 %, p = 0,494 ; 20,7 % contre 24,4 %, p = 0,709). Les données issues de notre étude sont en faveur d'un bénéfice à l'utilisation du TCZ chez les patients atteints de sclérodermie systémique, y compris en association avec d'autres immunosuppresseurs et avec des effets sur plusieurs manifestations de la maladie. En effet, le traitement a démontré une efficacité significative sur la fibrose cutanée, l'arthrite, l'atteinte myocardique et la SSc-PI. Les infections ayant conduit à l'arrêt du traitement sont restées limités et en accord avec les données observées dans d'autres maladies. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the prevalence of AF in the cardiology department of the Hospital Principal of Dakar, then to evaluate the clinical, paraclinical, etiological and evolutionary profiles of AF and finally to identify the limits of its management in our context. This was a retrospective, descriptive, analytical, mono-centric study carried out at Hospital Principal of Dakar from January 2019 to August 2021. Were included, all patients admitted for atrial fibrillation, or patients who presented an atrial fibrillation during hospitalization, confirmed by electrocardiogram or long-term electrocardiographic recording during the study period. The prevalence of atrial fibrillation during the period of our study compared to the hospital population was 7.71%, with a sex ratio of 1.03. The mean age was 67.88 ± 14.09 years. We noted that 83.64% of patients had at least one cardiovascular risk factor, with 56.36% suffering from hypertension, 50.91% of sedentary person and 23.64% of diabetics. Clinically, 92.72% of the patients were symptomatic, with dyspnea predominating (70.91%). Cardiac arrhythmia was present in 85.45% of patients, and congestive heart failure in 47.27%. Long-term electrocardiographic recording was performed in 10 patients, showing 50% of paroxysmal atrial fibrillation. Sixty-three patients (57.27%) had permanent AF, twenty-three patients (20.91%) had persistent AF, fourteen patients (12.73%) had long-term persistent AF and ten patients (9.09%) had paroxysmal AF. Transthoracic echocardiography showed 57.27% of left atrial dilatation and 72.3% of reduced left ventricular ejection fraction. Etiologies for cardiac causes were dominated by dilated cardiomyopathy (21.82%), followed by ischemic heart disease (17.27%). In terms of treatment, the most commonly used molecule was bisoprolol (38.18%), followed by digoxin (21.81%). Anticoagulants were used in 85.46% of cases. Acenocoumarol alone was used in 69.09% of patients. Drug-induced cardioversion was attempted in 2 patients without success, and 4 patients benefited from external electric shock with 3 successes. Most patients had a favorable outcome, but 34.54% suffered hemodynamic complications (18.18%) and thromboembolic ones as well (16.36%). In-hospital mortality in our series was 20%. It was significantly related to heart failure, with a left ventricular ejection fraction < 35% (p < 0.001). Atrial fibrillation is serious because of its hemodynamic, thromboembolic and rhythmic complications. The high mortality is explained by the underlying condition, but also by the delay in management with late diagnosis and, above all, the unavailability of ablation procedures in our context. [ABSTRACT FROM AUTHOR]

Congestive heart failure (HF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor a better follow up might be beneficial. PRADO-IC program is provided in order to improve the transition of care. To evaluate PRADO-IC program in term of healthcare consumption and prognosis in a cohort of patients hospitalized for decompensated HF, using the insight of the national data base SNDS (Système National de Données de Santé). From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in the PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC (P group) or not (control group (C)). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. The secondary end points were time to the first contact with a general practitioner (GP), a cardiologist, CHF drugs prescription, and others follow up data. Six hundred and fifteen patients were included, 254 in the P group and 361 in the C group. Patients in the P cohort presented more frequently severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (n = 47; 18.5% P group vs. n = 65; 16.2% C group, p = 0.87) did not differ in both groups. There was no significant difference in one-year re-hospitalization rate for HF (n = 93, 36.6% in P group vs. n = 133, 26.8% in C group, p = 0.95). Time to the first contact with the GP was shorter in P group (8.00 vs. 18.50 days, p < 0.0001). Time to first hospitalization (69.0 vs. 37.0 days, p = 0.028) and the length of hospitalization (6.0 vs. 4.0 days, p = 0.045) were longer in P group. There was no difference for HF drugs prescription rate between the two groups. Our study shows that the PRADO-IC program concerned more severe patients. Despite this, the one-year mortality and the HF readmission rates are similar between the two groups. The follow up is improved in P group. [ABSTRACT FROM AUTHOR]

Le thrombus intracardiaque (TIC) représente une des facettes des maladies thromboemboliques. Couramment favorisé par des troubles du rythme (fibrillation auriculaire), néanmoins, d'autres affections systémiques peuvent prédisposer à la formation de TIC. Nous avons réalisé une analyse rétrospective des dossiers des patients ayant des thrombi intracardiaques dans notre service de 2019 au janvier 2024, 9 cas ont été recueillis, nous avons étudié leurs caractéristiques épidémiologiques, circonstance de découverte, localisation, étiologies, complications et évolution. neuf patients ont été colligés : 6 hommes et 3 femmes, âgés en moyenne de 46 ans avec des extrêmes de 17 et 91 ans. La découverte était échographique dans tous les cas, demandée dans le cadre de l'enquête d'une fièvre prolongée, une douleur thoracique, une ischémie aiguë périphérique, un bilan étiologique d'un accident vasculaire cérébrale (AVC) ischémique ou dans le cadre d'un bilan lésionnel d'une vascularite. Le siège du thrombus était : le ventricule gauche (VG) : 5 cas, oreillette droite(OD) : 4 cas. L'origine était rattachée à une maladie de Behçet (MB) dans 4 cas (2 femmes et 2 hommes), tous localisés au niveau de l'OD : isolé dans 1 cas, associé a un syndrome (sd) de Budd-Chiari dans un cas, a un sd de Hughes-Stoven dans un autre cas, et le 4e cas associait une embolie pulmonaire. Les autres étiologies étaient : une cardiomyopathie dilatée d'origine ischémique dans 4 cas : 1 thrombus intra-VG isolé dans un cas, et compliqué d'un AVC ischémique dans le 2e cas, et 3 thrombi intra-VG compliqués de plusieurs foyers d' accident vasculaire ischémique dans le 3e cas, et le dernier cas un thrombus intra-VG révélé par une ischémie des membres inférieurs ; chez la dernière patiente l'étiologie du thrombus était une arythmie cardiaque par fibrillation auriculaire compliquée d'une ischémie digitale. Le traitement était basé sur l'anticoagulation dans tous les cas en association au traitement de l'étiologie sous-jacente, l'évolution était favorable dans tous les cas : régression de plus de 80 % au bout de 1 mois dans plus de 50 % des cas, et disparition après 4 mois en moyenne, sans recours à la chirurgie aucune complication hémorragique n'a été constatée. Dans notre série les étiologies principales des TIC étaient la cardiopathie ischémique et la MB 45 % pour chacune, contrairement a la FA qui ne présentait que 10 %. Les thrombi intracardiaques au cours des CMD ischémiques étaient tous intra-VG souvent apicaux, avec des complications thromboemboliques dans 75 % des cas, a l'opposé les TIC au cours de la MB siégeaient en intra-OD, non compliqués, révélateurs de la maladie dans50 % des cas et associés aux autres manifestations vasculaires. Nos résultats sont compatibles aux données de la littérature ou on trouve que les TIC sont des manifestations très rares dans la MB et touchent souvent le cœur droit, adhérant à la paroi ce qui explique leur caractère peu emboligène, et associés aux autres atteintes vasculaires thrombotiques et anévrysmales, le traitement repose sur la corticothérapie, les immunosuppresseurs associes a l'anticoagulation, la chirurgie est réservée en cas d'échec du traitement médical. D'autres pathologies peuvent favoriser la formation des TIC, inflammatoire, néoplasique, thrombophilie acquise ou constitutionnelle non retrouvées chez nos patients. Les TIC compliquent plusieurs pathologies cardiaques et systémiques. Leur formation reste dans tous les cas, un tournant pronostique à court et à long terme avec un risque de complication embolique parfois révélatrice et sévère. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This document is a quiz corner from the Canadian Veterinary Journal. The first question describes the case of an 8-year-old neutered male domestic shorthair cat with symptoms of exercise intolerance, panting, anorexia, weight loss, and vomiting. The physical examination reveals a systolic murmur and weak femoral pulses. The diagnosis is feline hypertrophic cardiomyopathy (HCM), which is characterized by biatrial enlargement and left ventricular hypertrophy. The second question discusses the case of sporadic sudden deaths in 2-month-old pigs, which is caused by mulberry heart disease due to vitamin E and selenium deficiency. The prevention method is to supplement animals with injectable vitamin E. [Extracted from the article]

Background: Women and racialized minorities continue to be underrepresented in cardiovascular (CV) trial outcomes data, despite comprising a significant global burden of CV disease. This study evaluated the impact of trial characteristics on the temporal enrollment of women and racialized minorities in prominent CV trials published in the period 1986-2023. Methods: MEDLINE was searched for CV trials published in The Lancet, the Journal of the American Medical Association, and the New England Journal of Medicine. Participant and investigator demographics, types of interventions, clinical indications, and funding sources were compared according to the enrollment of women or racialized minorities. Results: From 799 studies, including 4,071,921 patients, the enrollment of women and racialized minorities significantly increased from 1986 to 2023 (both P ≤ 0.001). Although the enrollment of women varied by trial indication, comprising 25.0% of coronary artery disease, 35.2% of noncoronary and/or vascular disease, 13.8% of heart failure, 17.0% of arrhythmia, and 28.7% of other CV trials (P ≤ 0.001), it did not differ by peer-reviewed vs industry funding. First authors who were women were more likely than first authors who were men to enroll significantly more women (P = 0.01). Conclusions: Active efforts to increase diverse enrollment, along with improved reporting, including of sex and race, in future CV trials may increase the generalizability of their findings and applicability to global populations. RÉsumÉ: Contexte: Les femmes et les groupes racisés demeurent sous-représentés dans les données de résultats d’essais cliniques sur les maladies cardiovasculaires (CV) malgré l’important fardeau global associé à ces maladies. Cette étude visait à évaluer l’effet des caractéristiques des essais sur la sélection temporelle des femmes et des membres de groupes racisés dans les essais portant principalement sur les maladies CV durant la période de 1986 à 2023. Méthodologie: La base de données MEDLINE a été consultée à la recherche d’essais sur les maladies CV publiés dans The Lancet, Journal of the American Medical Association et New England Journal of Medicine. Les données démographiques des participants et des chercheurs, les types d’interventions, les indications cliniques et les sources de financement ont été comparés en fonction de la sélection des femmes ou des membres de groupes racisés. Résultats: Dans 799 études cumulant 4 071 921 patients, la sélection des femmes et des membres de groupes racisés a augmenté significativement entre 1986 et 2023 (p ≤ 0,001 dans les deux cas). Bien que la sélection des femmes variait en fonction des indications des essais, soit 25,0 % dans les essais portant sur les coronaropathies, 35,2 % pour les maladies non coronariennes et/ou vasculaires, 13,8 % pour l’insuffisance cardiaque, 17,0 % pour l’arythmie et 28,7 % pour d’autres maladies CV (p ≤ 0,001), elle ne différait pas selon que les études étaient révisées par des pairs ou qu’elles étaient financées par l’industrie. Lorsqu’une femme était l’autrice principale, le nombre de femmes sélectionnées était susceptible d’être plus élevé que lorsque l’auteur principal était un homme (p = 0,01). Conclusions: Des efforts actifs pour diversifier davantage la sélection des participants et mieux rendre compte des différences, notamment en ce qui concerne le sexe et la race, pourraient élargir la portée des conclusions des futurs essais sur les maladies CV et leur application à l’ensemble de la population.

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Gender-affirming mastectomy surgery is highly desired within both transmasculine and nonbinary patient populations. The development of cardiac arrhythmias has been reported within this population. Acute intraoperative bradycardia in patients undergoing gender-affirming mastectomy has not been well described previously. This study aimed to describe the frequency of acute intraoperative relative bradycardia in patients undergoing gender-affirming mastectomies and identify potential risk factors that contribute to its occurrence. Methods: A retrospective review was performed for all patients who underwent gender-affirming mastectomy at a single institution. Data regarding patient demographics, comorbidities, and perioperative course were collected. Patients were separated into those who did and did not develop acute intraoperative bradycardia. The definition of relative intraoperative bradycardia was a heart rate below sixty beats per minute. Logistic regression was performed to determine which variables were predictive of bradycardia. Results: A total of 337 patients underwent gender-affirming mastectomy between January 2018 and January 2023. Of these patients, 144 (42.7%) experienced acute intraoperative relative bradycardia, with 97 (67.4%) requiring anesthetic intervention and 5 (3.5%) requiring halting or abortion of surgery. Two patients (1.4%) required compressions for asystole. Fluoxetine as an outpatient medication (OR: 2.63, P  = .002) and harvest of a nipple graft (OR: 2.77, P  = .018) were associated with a significantly increased risk of developing acute intraoperative bradycardia. Conclusion: Acute intraoperative relative bradycardia may be a unique phenomenon in patients undergoing gender-affirming mastectomies due to variables specific to this patient population. A future study comparing patients undergoing gender-affirming mastectomy to those undergoing elective breast surgeries is forthcoming to assess further risk factors., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s).)

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is characterized by maintaining comparatively stable blood pressure and does not influence the cardiac conduction system, which renders it a reasonable choice for general anesthesia for cardiac ablation. We aimed to evaluate whether remimazolam is associated with a decreased incidence of intraoperative hypotension compared with desflurane., Methods: In this single-centre, parallel-group, prospective, single-blind, randomized clinical trial, we randomized patients (1:1) into a remimazolam group (remimazolam-based total intravenous anesthesia) or desflurane group (propofol-induced and desflurane-maintained inhalational anesthesia) during cardiac ablation procedures for arrhythmia. The primary outcome was the incidence of intraoperative hypotensive events, defined as mean arterial pressure of < 60 mm Hg at any period., Results: Overall, we enrolled 96 patients between 2 August 2022 and 19 May 2023 (47 and 49 patients in the remimazolam and desflurane groups, respectively). The remimazolam group showed a significantly lower incidence of hypotensive events (14/47, 30%) than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95% confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was associated with a lower requirement for bolus or continuous vasopressor infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI, 0.41 to 0.76; P < 0.001). No between-group differences existed in the incidence of perioperative complications such as nausea, vomiting, oxygen desaturation, delayed emergence, or pain., Conclusions: Remimazolam was a viable option for general anesthesia for cardiac ablation. Remimazolam-based total intravenous anesthesia was associated with significantly fewer hypotensive events and vasopressor requirements than desflurane-based inhalational anesthesia was, without significantly more complications., Study Registration: ClinicalTrials.gov (NCT05486377); first submitted 1 August 2022., (© 2024. Canadian Anesthesiologists' Society.)

Background: Patients with complex congenital heart disease and Fontan palliation frequently develop extracardiac disease, including hematologic abnormalities, such as lymphopenia. However, the clinical implications of this finding are poorly understood and are therefore the topic of this investigation., Methods: Patients with Fontan physiology in our centre (1999-2018) were evaluated for the presence and impact of lymphopenia. The cohort was divided into a group with lymphopenia (L) (2 consecutive absolute lymphocyte counts ≤ 1∗10 3 K/ μL) and a group who had never had lymphopenia (NL). Clinical characteristics and hospital admissions (762 patient-years) were evaluated., Results: In 62 adult patients with Fontan physiology (aged 34 ± 9 years; 32 women [52%]), the patients who developed lymphopenia earliest did so 8 years after Fontan completion, with up to 60% of patients developing lymphopenia by 30 years. Lymphopenia was found to be associated with portal hypertension (varices, ascites, splenomegaly, and thrombocytopenia [VAST] score)-NL: 0 (0-2) vs L: 2 (0-4), P < 0.0001). A total of 76 heart failure and 81 arrhythmia-associated admissions occurred per 1000 patient-years. At 40 years post-Fontan, the probability of a heart failure admission was higher in the L group (L: 51 [86%] vs NL: 8 [14%], P < 0.01)., Conclusions: Adult patients with Fontan physiology and lymphopenia demonstrated portal hypertension and lymphatic dysfunction more commonly, perhaps suggesting that this may be a marker of Fontan congestion and early Fontan failure. Further investigation into the relationship between lymphopenia, clinical outcomes, and Fontan function is needed., (© 2024 The Authors.)