Introduction: Dyspnoea is a prevalent symptom associated with significantly reduced health-related quality of life (HRQoL). Accurate estimates of the severity and intensity of dyspnoea using standard tools in the clinic are important for the assessment of the severity of symptoms at later follow ups. Objectives: The current study had two aims. First, we sought to determine one-year changes in dyspnoea and health-related quality of life in patients with cardiac or respiratory diseases. Second, we sought to analyse the long-term associations between one-dimensional measurement methods and a generic instrument reflecting the multi-dimensionality of dyspnoea using the Short-Form Health Survey (SF-36). Methods: We prospectively recruited adult dyspnoeic patients in a rural primary health care centre. Participants were assessed for demographics, symptoms, medications, and N-terminal B-Type natriuretic pro-peptide (Nt-proBNP) level, and underwent spirometry and echocardiography. Results were analysed at baseline and one-year after enrolment. Based on the assessment results, we categorized the patients into one of three groups as the underlying disorder for dyspnoea: cardiovascular, pulmonary or psychiatric disease. Results: The ordinal scales [New York Heart Association (NYHA), modified Medical Research Council (mMRC) and Verbal Rating Scale (VRS)] indicated a slight but not significant decrease in dyspnoea severity, whereas the VAS showed a significant reduction in dyspnoea severity (p = 0.001) overall as well as in the cardiovascular group. By contrast, patients with pulmonary disease showed no improvement. HRQoL, as determined by the eight domains of SF-36, was unchanged, and dyspnoea severity had no impact on the worsening of health status. The correlation coefficient by test-re-test (reliability) of values at baseline and at the end of the study was highly significant. Conclusion: As appropriate measurements for the assessment of dyspnoea using one-dimensional scales, both mMRC and VAS should be considered for measuring changes in dyspnoea severity. VAS should be considered particularly for long-term changes in dyspnoeic patients with cardiovascular disorders. Changes in the different domains of the SF-36 were not seen after one year.

Introduction: Early B-cell factor 1 (EBF1) gene participates in the development of the central nervous system and is expressed in adipocytes and olfactory neuroepithelium, which is intimately linked with the emotion and reward system in adults. For this reason, it could be linked to tobacco addiction Objective: The aim of this study was to determine probable association between the EBF1 gene rs4704963 SNP (T>C) with smoking habits in a population of patients with multiple coronary risk factors (CRF) with and without acute coronary syndromes (ACS). Materials and methods: Between December 2015 and March 2017, 104 consecutive patients with two or more risk factors, with or without ACS were included. A 10-mL blood sample was collected from all the patients for SNP determination. DNA genotyping was carried out using the nested PCR technique and subsequent sequencing. Results: Mean age was 59.1 ± 9.17 years and 59.6% were men. The most common CRF were smoking habits (60.6%) hypertension (56.7%) and diabetes (48.1%).None of the patients had the homozygous T / T haplotype while 17 patients (16.3%) presented the T / C haplotype for heterozygous SNP. Among the 17 patients with the SNP detected, 16 (94.1%) were smokers compared to 54% of smokers in those patients without the SNP detected (p = 0.002). In those patients with ACS and smoking habits, the SNP was detected in 21.3% versus 0% in those with ACS and no history of smoking habits (p= 0.029) Conclusion: A significant association was observed between the EBF1 gene rs4704963 SNP (T> C) with smoking habits in patients with ACS and in those with CRF without ACS. Further research including more patients is necessary to confirm these findings in order to customize decision-making to prevent this addiction and indicate the appropriate treatment when smoking is present.

Cardiovascular diseases continue to be the primary cause of death worldwide, thus making their high burden a call for adequate prevention strategies. Estimating individual risk of suffering cardiac or cerebral vascular events allows the implementation of disease-modifying measures.Risk stratification charts based on traditional risk factors (sex, age, smoking, hypercholesterolemia, diabetes mellitus and hypertension) are the most recommended methods, given their easy use, high applicability and predictive value. Nevertheless, intermediate risk patients undergoing further stratification may require additional tools, such as serological markers and imaging. This review focuses on the utility and applicability of various tools designed for cardiovascular risk assessment.

Background: Emergency department clinicians often overlook asymptomatic hypertension (HTN). Clinical decision support can help improve adherence to the emergency nursing and emergency medicine clinical policy for asymptomatic HTN. While the policy indicates referral for all adults with two or more elevated blood pressures, less than 10% of patients are referred. We sought to determine the efficacy of an electronic health record clinical reminder on nursing (RN) reassessment of blood pressure (BP) for hypertensive patients. Methods: We conducted a 2-arm, pilot RCT, at an academic medical center in New York City. 107 RNs were randomized to the control group or to the intervention of a (Best Practice Alert) (BPA) reminding him/her to recheck the BP in adult patients with an initial BP reading =140/90 mmHg. Descriptive statistics that included univariate and bivariate analyses were used to obtain adjusted measures of association between the intervention and control group. Results: RNs were more likely to repeat BP after receiving a BPA alert (56%) compared to RNs who did not receive an alert (44%) (OR=2.3, CI 2.1-2.5; p<.001). Patients who received BP reassessment were more likely to be triaged category 4 (OR 2.88, CI 1.81-4.59, p=.0001); age>75 years (OR 1.47; CI 1.07-2.03; p=.02); had Stage II HTN (OR 3.48; CI 2.63-4.59, p=.0001) and an ED length of stay of 3-4 hours (OR 5.85; CI 4.43-7.73; p=.0001).

Objective: To identify relationship between echocardiographic parameters variations and risk of postoperative atrial fibrillation (POAF) after cardiac valve surgery. Design: Prospective. Case-control study. Setting: A university hospital. Participants: We analysed the incidence of POAF in 90 patients undergoing elective heart valve surgery. POAF was considered when episodes equal or longer than 5 minutes, and those under 5 minutes with hemodynamic disturbances. Interventions: None.Measurements and main results: POAF incidence was 36.7%. Preoperative echocardiographic study showed higher systolic pulmonary pressure (p: 0.047) and longer atrial electromechanical interval (AEI) (0.049) in POAF group. Postoperative echocardiographic evaluation revealed higher TAPSE decreasing related with preoperative values (8.18± 4.33 mm in No-POAF vs. 10.35 ± 3.83 mm in POAF group) (p: 0.026). In multivariate logistic regression POAF correlated with age> 65 years (p: 0.007) OR: 4.80; IC 95% (1.52-15.14), longer preoperative AEI (p: 0.042) OR: 1.029 IC 95% (1.001-1.059), higher TAPSE reduction (p: 0.040) OR: 1.15 IC 95% (1.006-1.316) and postoperative left atrial volume index> 36 ml / m2 (p = 0.0203) OR: 3.63; 95% CI (1.23-11.92).Conclusions: After heart valve surgery, POAF favoured right ventricular dysfunction (evidenced by higher postoperative TAPSE decreasing) and impaired early left atrial remodelling. In older patients and those with preoperative longer AEI, biatrial pacing and pharmacological prophylaxis might prevent these undesirable POAF effects.