Biography:

Abstract:

Rheumatic Heart Disease Treatment Cascade in Uganda, A case Study of Infectious Diseases Institute.

Fauzia Zalwango,

Infectious Diseases Institute, Uganda

Abstract

Introduction: Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda to identify appropriate targets for intervention.

Methods and Results: Using data from the Uganda RHD Registry (n=1504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016; (2) retained in care; (3) appropriately prescribed BPG; and (4) optimally adherent to BPG (>80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (interquartile range) age was 23 (15–38) years, 69% were women, and 82% had clinical RHD. Median follow-up time was 2.4 (0.9–4.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% confidence interval, 54.1%–59.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription (91.6%; 95% confidence interval, 89.1%–93.5%) and optimal adherence (91.4%; 95% confidence interval, 88.7–93.5). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence.

Conclusions: Our study suggests that improving retention in care—possibly by decentralizing RHD services—would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.

Biography:

Abstract:

GFOGER Peptide Inhibits Vascular Calcification in Vitro by Blocking the Osteogenic Switch of Vascular Smooth Muscle Cells

Ali Mansour

University of Picardie Jules Verne, France

Abstract

Cardiovascular Diseases (CVDs) are classified on top of the list among different death leading causes in the world. Calcification of the vessel wall accounts for high death rates in patients with many diseases like diabetes, atherosclerosis and Chronic Kidney Disease (CKD). Vascular Calcification (VC) is considered as an active multifaceted pathology that resembles bone physiology and regulated by inductive and inhibitory mechanisms. During the calcification process, Vascular Smooth Muscle Cells (VSMCs) release Extracellular Vesicles (EVs) which act as nucleating foci for crystallization through their interaction with type I collagen, also they undergo active osteogenic process to become osteoblast like cells. Using Surface Plasmon Resonance (SPR) in our previous studies, we successfully identified a specific, six amino acid, collagen sequence (GFOGER) that can be recoginized by integrin expressed on EVs. Recently, we chemically synthesized this GFOGER peptide and we hypothesized if it is able to prevent VC in vitro and ex-vivo. Our results showed that GFOGER peptide decreased Pi-induced calcification, by 66% and 60% in MOVAS-1 and primary human VSMCs respectively. Moreover, GFOGER sequence was effective against aortic rings cultured ex-vivo where it decreased Pi-induced calcification by 91%. At the molecular level, the expression of different osteogenic markers including Runt-related transcription factor 2 (Runx2), Matrix Gla-Protein (MGP), Osteocalcin (OCN) and Tissue Non-Specific Alkaline Phosphatase (TNAP) were downregulated in the presence of the GFOGER peptide. These results suggested that inhibition of VC by GFOGER peptide is in part mediated by a decrease of the osteogenic de-differentiation of vascular smooth muscle cells. Finally, we aim to expand our study in order to check the capacity of GFOGER peptide to inhibit VC on in vivo models.

                                                                            alimansour93@hotmail.com

Biography:

Abstract:

Concordance between the Different Cardiovascular Risk Scores in People with Rheumatoid Arthritis and Psoriasis Arthritis

Namwanje Zulpher,

^{Uganda Virus Research Institute, Uganda}

Abstract

Aim: To determine the cardiovascular risk and the concordance between the different scores in people with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods: Observational descriptive study of prevalence. Performed in the Rheumatology Service and the Clinical Epidemiology and Biostatistics Unit of the University Hospital Complex of Makerere University Medical School. Patients diagnosed with RA or PsA, older than 18 years of age were included.

Measurements: sociodemographic, anthropometric variables of the disease, comorbidity, cardiovascular risk, and therapeutic management. Results. 151 subjects (75 RA and 76 PsA) were studied. The average age was 57.9 ± 12.2 years, 61.6% being women. The average of the Charlson index was 2.8 ± 1.5. 43% were overweight. 46.5% were classified as cardiovascular risk, and the average percentage was 33.3% by Framingham. The best agreement has been between Framingham and Dorica (k = 0.709; ), classifying more than 80% of the cases in the same risk categories.

Results: The general and comorbidity characteristics are shown in Table 1. The mean age at the time of the interview was 57.9 ± 12.2 years, 61.6% being women. The mean evolution of the disease was 9.2 ± 7.6 years, and the Charlson comorbidity index was 2.8 ± 1.5. In terms of BMI, a high percentage of overweight (43%) and obesity (28.5%) was observed. 19.9% declared to be a smoker and 31.8% ex-smoker. 71.5% did not present a family history of the study pathologies (RA and PsA).

Conclusions: The most prevalent risk factors were overweight and obesity, followed by smoking and hypertension. The prevalence of patients with moderate/high cardiovascular risk varies according to the score used, the levels of concordance being the scores of Framingham and Dorica. Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are two of the most prevalent rheumatic diseases which have an impact on the health system . Among the repercussions of these diseases, their relationship with an increase in cardiovascular disease (CVD) , morbidity, and mortality  stands out, owing to the role played by inflammation in both pathologies . Thus, it has been observed that the CVD condition is the main cause of death, both in people with RA and in people with PsA . In the case of RA, life expectancy has been reduced from 3 to 10 years compared with the general population . The cardiovascular risk (CVR) factors described in the literature are cholesterol, diabetes, hypertension, genetic inheritance, stress, tobacco, physical inactivity, obesity, and heart rate . The CVD establishes the probability of suffering in a given period of time, generally 5 or 10 years, a cardiovascular episode.

Biography:

Abstract:

Fulminant Course of Valvular Insufficiency on a Pediatric Patient with Systemic Lupus Erythemathosus

Abel Gidey

Ayder Comprehensive Specialized Hospital, Ethiopia

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that can affect the multiple organs of the body. Cardiac involvement among children with SLE ranges in various studies from 12 to 54 percent with varied in nature and severity.  Valvular lesion is the most encountered form of heart disease in systemic lupus erythematosus (SLE). The mitral valve being the commonest site.

Case report: We report a case of 16 years old male adolescent who was referred from district hospital in Tigray region. He was newly diagnosed Systemic lupus erythemoatosus with rapid progression of valvular insufficiency and congestive heart failure. This is one of the rare case reports with diagnostic and therapeutic challenge.

Conclusion: Cardiac involvement in systemic lupus erythematosus is a multifaceted disease with irreversible valvular damage. Frequently changes over short period of time and is associated with substantial morbidity and mortality unless immediate medical and/or surgically intervened.

                                                                                                               abumd23@gmail.com

Biography:

Abstract:

Waist Circumference measures predict the cardiovascular risk parameter

Niraj Khatri Sapkota

Chitwan Medical College, Nepal

Abstract

Introduction: Systolic and Diastolic blood pressure are two variables of Blood pressure that can be precisely measured if right precaution be taken and hence provides an attention to understand the cardiovascular risk parameters such as atheresclerosis,Ischaemic Heart disease, Strokes that leads to premature death. Waist circumference is considered to be one of the important measurements that indicate deposition of fat bulk around waist region that is directly associated with insulin resistant, Hypertension other Cardiac-metabolic risk.

Aims: Hence, this study aims to find   waist circumference (WC) measurement strongly predicts hypertension one of the cardiovascular risk.

Methods: A community based cross sectional study was conducted by incorporating total of substantial number   (more than 100) of subjects in the data who were male only older than 25 years, non smokers, non alcoholic, didn’t have history of taking any type of medication, non vegetarian with normal physical activity and were residents in the urban and rural areas throughout, were included in the present study. Waist circumference referenced to umbilicus measured by non tensile and non flexible measuring tape and at the mean time height and weight were also recorded by standard device in order to calculate BMI and blood pressure was measured by Aneroid sphygmomanometer of the respective subject subsequently data analysis was made by using SPSS to compare the BMI and Waist circumference relationship with blood Pressure independently to identify their relationship with hypertension.

Results: Keeping few exceptional aside, Both BMI and Waist Circumference exhibited positive association with blood pressure, while the waist circumference was more strongly associated with hiking of blood pressure and also BMI is not always the relating parametric tool to metabolic disease as was conventionally considered.

Conclusion: The result and analytical data showed that (P<0.05) there is significant strong correlation of blood pressure with waist circumference comparatively more than BMI thus WC alone can significantly predict the co-morbidity therefore this study approach to suggest and hints to follow as a routine task for measuring Waist circumference while taking inference for diagnosing hypertension risk at least in male.

Recent Publications

1. Sapkota NK (2017). Effect of phototherapy in ionized Magnesium and bilirubin level in hyperbilirubinmic neonates. Innovare Journal of Medical Sciences 5(1):10-11.
2. Sapkota NK (2017). Pre-hypertension independent deleterious effect in body system. Innovare journal of Medical Sciences 2(4):1-2.
3. Sapkota NK, Swain KC (2017). Obesity, type 2 Diabetes mellitus and its management. Innovare Journal of Health Sciences 5(1):17-20.
4. Ram Lochan Yadav,  Khadka R ,  Agrawal K,   Thakur D,  Sharma D,  Shah DK, Yadav PK,  Sapkota NK, et al(2016). Analysis of cardiac autonomic modulation in normotensive obese and eutrophic adults of Nepal. International journal of research in Medical Sciences 4 (1):105-110.
5. Sharma D,  Paudel BH,  Khadka  R, Thakur D , Sapkota NK et al (2015). Time domain and frequency domain analysis of heart rate variability in elite Nepalese football players. International Journal of Biomedical Research 6(09): 641-646.

nirajkhatri78@gmail.com

Biography:

Abstract:

Rowan School of Medicine, USA

Objective: Atrial fibrillation is a common disorder which can potentially have multiple adverse outcomes.  One such outcome is the development of ischemic bowel disease.  The aims of this study are: to  evaluate the role of CHA2DS2-VASc score as a predictor of higher mortality in patients who have atrial fibrillation and ischemic bowel disease, i.e. if a higher CHA2DS2-VASc score is associated with higher mortality; to evaluate whether being on anticoagulation is associated with a lower mortality for such patients in this population. 

Methods: This retrospective study reviewed patients admitted to three community teaching hospitals (health system) from January 1, 2016, through October 15, 2018 with the primary diagnosis of atrial fibrillation and ischemic bowel disease. The subject cohort was gathered via the use of International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes. Baseline characteristics such as age, sex, CHA2DS2-VASc Score, and mean Cr, subjects use of anticoagulation were analyzed. Hazard ratios, P-values, Confidence Intervals, and a Cox proportional-hazards model for the baseline characteristics were calculated.  Kaplan-Meier curves were calculated and then plotted together for subjects on anticoagulation versus those not on anticoagulation. The area under the receiver operating characteristic (ROC) curve was employed to assess the predictive power of CHA2DS2-VASc score for mortality development among ischemic bowel disease patients with atrial fibrillation.

Results: Sixty-five patients were included. The majority of the patients were older than >75 (63%), female (69%), and had established HTN (68%). The mean CHA2DS2-VASc score was 4.25 with p value <0.009. Utilizing the cox proportional-hazards model, the hazard ratios for females, patients with diabetes mellitus, and CHA2DS2-VASc score were statistically significant with p-value <0.05 and hazard ratios with confidence intervals that did not include 1.

The area under the curve of ROC was 0.67, indicating a fair-to-poor marker with regards to the predictive power of CHA2DS2-VASc score for mortality development in patients with ischemic bowel disease patients and atrial fibrillation. When examining mortality in patients based on whether or not patients were on anticoagulation, the hazard ratio was 0.3588197057 (CI 0.08873281868) with P <0.05. The Kaplan-Meier curves demonstrate longer survival and less mortality for patients with atrial fibrillation on anticoagulation.

Conclusions: The predictive power of the  CHA2DS2-VASc score was relatively low. Our current results show that the CHA2DS2-VASc score had a statistically significant hazard ratio, meaning that a score >4 had increased mortality. Patients on anticoagulation had less mortality than patients not on anticoagulation. Going forward, physicians should opt for anticoagulation in patients with atrial fibrillation unless it is absolutely contraindicated.