Biography:

Soukeina Bassam, master 2 research student in Lebanese University. Amal Al-Hajje, Professor and instructor in Lebanese University, Director of this thesis.

Abstract:

Anticoagulation therapy is a cornerstone in managing patients with thromboembolic diseases. The aim is to evaluate the factors of imbalance of new oral anticoagulant (NOAC) and acenocoumarol and to identify drug-related problem (DRP) related to their use. A prospective cross-sectional study was conducted during five months in a tertiary care hospital. Factors affecting INR and PTT value were assessed. DRP were identified and categorized according to Pharmaceutical Care Network Europe classification system. Out of 258 patients, only 43.18% were able to achieve their target INR compared to 84.15% who had controlled PTT. Having renal disease, anemia or on dialysis are among the factors that affect the range of INR (p <0.05); whereas smoking, renal disease, anemia and taking anti-platelets therapy were significantly affecting PTT (p <0.05). The overall prevalence of DRPs was 87.2% with the highest prevalence in patients taking acenocoumarol (96%) compared to 76.7% on dabigatran and 59% on rivaroxaban. Drug interaction was the most frequent DRP (83.3%), followed by inappropriate monitoring (42.6%) and dose too high (26.7%). Patients on NOAC have more control on PTT and less DRPs with a wide therapeutic index that enables them to be taken in fixed doses without the need for laboratory monitoring.

Biography:

Mrs. Namrata Kafle is recently working as a Nursing Instructor in Padma Nursing College with background of  hardworking researcher, her field of research includes hypertension regarding to effect alteration by contraception also her research  interest  involves Mental Heaalth status in community based study, she is clinically exposed as an Staff Nurse in B.P Koirala Memorial Cancer Hospital Bharatpur ,Chitwan ,Nepal and also  served as a health suppervisor in Phase Nepal Project for more than year. She is obedient and has participated in different training such as Primary health Management Training Community Mobilization & Communication Training, and jn Child Protection Policy during her career.

Abstract:

INTRODUCTION

Menopause is a inevitable physiological phenomenon in which  cardiovascular risk factor (CRF) factors association is reported, but age at menopause (AAM) varies considerably and could affect the risk among post-menopausal women. The aim of the study was to clarify whether AAM is associated with hypertension, independent of chronological age, lifestyle and hormone replacement therapy (HRT), in Nepalese women.

METHODS:

A cross-sectional  study was conducted using the baseline survey in 60 female among them 30 were post menopausal aged (45-55) study group and 30 pre menopausal aged (35-44) women considered to be control group.The prevalence of hypertension in  AAM groups were compared by using statistical analysis. Daily lifestyle such as smoking, alcohol consumption, and doing brisk physical activity and women  under oral Contraceptive pill were not included in this study.

RESULTS:

The estimated risk (odds ratio: OR) was significantly higher in post-menopausal women and linearly elevated according to the AAM groups, and the late AAM group was more likely to have hypertension however, after adjustment for age, BMI (kg/m(2)), HRT and lifestyle, AAM  showed  no significant association with cardiovascular variables such as systolic, diastolic and pulse pressure when just considered the menopausal status, therefore  AAM group is not associated with increased risk of hypertension compared with premenopausal control group.attributed just becasue of menopausal status.

CONCLUSIONS:

There is no any association of hypertension relevant to menopausal status confounding other parameters such as age, BMI, life style and HRT therapy in the post-menopausal women.

Biography:

Rahul Gupta MD ,Department of Internal Medicine^a and Department of Cardiology^b, Westchester Medical Center and New York Medical College, Valhalla, NY 10595

Abstract:

Background.  Posterior pericardiotomy (PP) is a simple surgical technique that may reduce the risk of post-operative atrial fibrillation (POAF) by allowing for drainage of pericardial fluid into the left pleural space, reducing the incidence of pericardial effusion that may trigger POAF.

Methods. This systematic review sought to determine the impact of posterior pericardiotomy on incidences of POAF, pericardial effusion, and the length of hospital stay after coronary artery bypass grafting (CABG). Electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through December 15, 2018 were performed. The primary outcome of our study was reduction in POAF following PP. Secondary outcomes were reductions in pericardial effusion and length of hospital stay. A Mantel-Haenszel random effects model was used to summarize data across treatment arms. Heterogeneity between studies was assessed using the chi square test and was considered significant for p values < 0.10 or I² > 50%.

Results.  A total of 14 randomized controlled trials consisting of 2,462 patients undergoing CABG were included in the meta-analysis. Patients who underwent PP demonstrated significant reduction in POAF (OR 0.34; 95% CI 0.21–0.55, p < 0.001) and pericardial effusion (OR 0.11; 95% CI 0.06–0.20, p < 0.001) as compared to controls, respectively. However, heterogeneity between studies was significant (I² 73% and 70%, respectively). No difference was observed in terms of length of hospital stay (standard mean difference -0.06; 95% CI -0.26 - 0.14, p = 0.56; heterogeneity I² 62%, p = 0.02). Number needed to treat to prevent POAF was 6.6 (95% CI 5.38-8.39).

Conclusion. Posterior pericardiotomy is a simple intraoperative technique that can reduce the risk of post-operative atrial fibrillation. These results should be interpreted with caution due to heterogeneity between the studies.

Biography:

Dipesh Ludhwani completed his medical school in India before working as a research assistant at Rutgers New Jersey Medical School. He started his Internal Medicine residency at Chicago Medical School, Northwestern Mchenry hospital in 2017. Currently a second-year resident, Dr. Ludhwani has been unanimously selected as the future third year chief resident for his residency program. He is interested in pursuing Cardiology fellowship and has published and presented numerous abstracts at regional and national conferences.

Abstract:

Introduction: The role of obesity in cardiovascular mortality is controversial. Obesity paradox has been widely attributed to smoking in underweight. Large scale studies analyzing outcomes of peripheral arterial disease (PAD) and obesity while accounting for confounders such as smoking are lacking.

Method: We identified admissions with a primary discharge diagnosis of PAD in the United States National Inpatient Sample (NIS) of 2016 using the ICD-10 CM diagnosis code. These admissions were further grouped based on the presence or absence of obesity as a secondary diagnosis. Obesity was defined as Body Mass Index (BMI) ≥ 25. Propensity scores were calculated to match both groups and control for age, smoking, diabetes amongst other confounders. Multivariate logistic and linear regression analysis was performed to calculate the odds ratio for amputation, need for intervention (angioplasty or bypass), in-hospital mortality and length of stay. PAD admissions without obesity were selected as the reference population. Results: Among 248,288 PAD-related admissions, 41,618 had a secondary diagnosis of obesity. After calculating propensity scores for 1-1 matching 41,589 admissions in PAD and obesity group were compared with a similar amount of admissions in the reference population. Patients with concomitant diagnosis of obesity were associated with lower odds of amputation (OR=0.90, 95% CI=0.84-0.95, p<0.001), need for intervention (OR=0.66, 95% CI=0.62-0.69, p<0.0001), in-hospital mortality (OR=0.81, 95% CI=0.74-0.87, p<0.0001) and length of stay (B=0.5, SE B=0.04, p<0.0001). The odds of having acute kidney injury were higher in the obese group (OR=1.30, 95% CI=1.26-1.34, p<0.0001) compared to the reference population.

Conclusion: The odds of amputation, invasive PAD intervention and in-hospital mortality were lower in obese patients. Despite increasing the risk of hypertension, diabetes, and overall prevalence of PAD, obesity paradox continues to exist with better short-term prognosis in these patients. Future studies looking into the pathophysiology behind this phenomenon are needed.

Biography:

Rabia has recently completed her D.Phil. from University of the Oxford, United Kingdom. She is now working as Assistant Professor at Interdisciplinary Research Centre in Biomedical Materials, Lahore, Pakistan. She has 10 years of research experience in tissue engineering and biomaterials with publishing experience in various peer-reviewed high impact factor national and international journals. At IRCBM she is working on improving design, biochemical, and biomechanical properties of natural polymer based degradable scaffolds for aortic valve tissue engineering.

Abstract:

Statement of the Problem: An ideal scaffold for the regeneration of valvular tissue should replicate the natural heart valve extracellular matrix (ECM) in terms of microstructure and properties ^{1, 2}. Tissue engineers have achieved limited success so far in designing an ideal scaffold; scaffolds lack in mechanical compatibility, appropriate degradation rate, and microstructural similarity ³.

Methodology: This piece of research is the first attempt to develop interlaced scaffolds from collagen type I and hyaluronic acid (HA), polymers found in the natural valve, via a modified carbodiimide based crosslinking technique.

Findings: Scanning electron micrographs (SEM) and images of Alcian blue – Periodic acid Schiff (PAS) stained samples suggested that our crosslinking technique yielded an ECM mimicking microstructure with interlaced bands of collagen and HA in the hybrid scaffolds. Hybrid scaffolds also offered a wide range of pore size (66 – 126 µm) which fulfilled the criteria for valvular tissue regeneration. Swelling studies revealed that crosslinking densities of parent networks increased with increasing the concentration of the crosslinking agents whereas crosslinking densities of hybrid scaffolds averaged from those of parent collagen and HA networks. Fourier transform infrared spectroscopy (FTIR) showed that this technique could crosslink collagen type I and HA without denaturation. Cardiosphere derived cells (CDCs) attached and proliferated on all scaffolds in cell culture experiments as confirmed by AlamarBlue® assay and SEM images. The increase in crosslinking density, however, affected the cell affinity because of the engagement of the cell-attachment sites in the crosslinking process. CDCs seeded scaffolds also showed 50 % increase in bending modulus after 28 days of culture.

Conclusion & Significance: Findings from this study indicated that collagen/HA interlaced scaffolds have the potential to fill in the niche for designing an ideal TEHV ⁴. Furthermore, the properties of the interlaced scaffolds, fabricated by our crosslinking technique, can be tailored by controlling the crosslinking density which can also widen the scope of these scaffolds for other tissue engineering applications such as bone, cartilage etc.