Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot: Systematic Review and Meta-analysis

BackgroundAlthough there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia.MethodsWe used random-effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsOf the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1% (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95% CI, 1.09-1.53, P = 0.001) per 5% decrease in LVEF. Similarly, LVEF < 40% was also a predictor of CAE (HR 3.22, 95% CI, 2.16-4.80, P < 0.001).ConclusionsLV systolic dysfunction was an independent predictor of CAE, and we observed a 30% increase in the risk of CAE for every 5% decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40% compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem.     

Nutrient and Antioxidant Properties of Oils from Bagasses,Agricultural Residues,Medicinal Plants,and Fodders

Objective: This study evaluated the physicochemical properties, fatty acid (FA) and phytochemical compositions, and free radical–scavenging potentials of oils from the bagasses: Costus afer stem (CA) and Saccharum officinarum stem (SB); agricultural residues; corn cobs (CC); tigernut chaff (TB); peanut hulls (GH); medicinal plants: Sphenocentrum jollyanum leaves (SJ) and Senna alata leaves (CS); and fodders: Pennisetum purpureum (PP), Panicum maximum (PM), and Chloris gayana stalks (CG).

Method: Oils from the samples were extracted using a mixture of n-hexane and isopropyl alcohol (3:2). The oils were analyzed for physicochemical properties using standard procedures, phytochemicals and FAs contents using gas chromatography-fluorescent ionization detection, and free radical–scavenging potentials using spectrophotometric methods of determination.

Results: The bagasse and residue oils contained lower moisture contents (1.13%–2.38%) and acid values (1.89–9.20?mg/KOH/g), while the GH oil produced the least refractive indices, saponification value, and oil yield. CA oil contained 78% saturated FA, while SB oils contained 73.65% saturated FA and an abundance of lignoceric, palmitoleic, oleic, and arachidic acid. CC oil contained mostly behenic acid (19.65%), and GH oil produced 87.04% saturated FA, while TB oil produced 56% unsaturated FA. Oils from SJ, CS, PP, PM, and CG contained between 48.34% and 57.09% unsaturated FA. The phytochemical composition showed that ribalinidine and sapogenin were most abundant in PM oil, while lunamarine, kaempferol, and catechin were most abundant in SJ oil. GH oil produced the highest amounts of phytate (53.81?µg/ml) and oxalate (39.47?µg/ml). TB oil and oils from SJ and CS, especially at higher concentrations, matched the scavenging potentials of the standards used.

Conclusions: Due to the thermal stability and amount of short chain fatty acids (SFAs) of the SB, CA, CC, and GH oils, they are more suitable for non-food industrial purposes, while TB, SJ, and CS oil properties are recommendable for therapeutic purposes, especially for relief of oxidative stress.     

10-Year Heart Failure Outcomes From Nurse-Driven Clinics in Rural Sub-Saharan Africa

Nurse-led delivery care models have the potential to address the significant burden of heart failure in sub-Saharan Africa. Starting in 2006, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health–Rwanda), decentralized heart failure diagnosis and care delivery in the context of advanced nurse-led integrated noncommunicable clinics at rural district hospitals. Here, the authors describe the first medium-term survival outcomes from the district level in rural sub-Saharan Africa based on their 10-year experience providing care in rural Rwanda. Kaplan-Meier methods were used to determine median time to event for: 1) composite event of known death from any cause, lost to follow-up, or transfer to estimate worst-case mortality; and 2) known death only. Five-year event-free rates were 41.7% for the composite outcome and 64.3% for known death. While death rates are encouraging, efforts to reduce loss to follow-up are needed.     

Examining the relationship between social media engagement and hospital revenue

Abstract

Effective use of social media by hospitals has the potential to improve hospitals’ financial performance by facilitating customer service and providing hospitals with a low-cost marketing platform. This cross-sectional study explored the relationship between hospital Facebook engagement and patient revenue in a simple random sample of United States short-term acute care hospitals. There was a positive relationship between Facebook engagement and hospital patient revenue for rural hospitals, but not for urban hospitals. Additional research is needed to identify the mechanisms through which hospitals’ social media presence influences consumer health purchasing behavior and profitability.