Effect of heart failure on the outcome of COVID-19 — A meta analysis and systematic review

BackgroundSeveral comorbidities have been associated with an increased risk of severity and mortality in coronavirus disease 2019 (COVID-19), including hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and chronic obstructive pulmonary disease.PurposeIn this systematic review and meta-analysis, we attempted to investigate the association between heart failure (HF) and poor outcome in patients with COVID-19.MethodsWe performed a systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and medRxiv with the search terms, “Heart failure” and “COVID-19”. The outcome of interest was mortality and poor prognosis (defined by incidence of severe COVID-19 infection, admission to ICU, and use of ventilator) in patients with preexisting heart failure with coronavirus disease.ResultsWe identified 204 potential articles from our search, and 22 duplicates were removed. After screening of the titles and abstracts of the remaining 182 articles we identified 92 potentially relevant articles. We excluded 74 studies due to the following reasons: four studies were systematic reviews, two studies were meta-analyses, three articles were literature reviews, and 65 articles did not report on the outcome of interest. Finally, we included the remaining 18 studies in our qualitative synthesis and meta-analysis. There were 21,640 patients from 18 studies. HF was associated with hospitalization in COVID19 HR was 2.37 [1.48, 3.79; p < 0.001], high heterogeneity [I², 82%; p < 0.001]. HF was associated with a poor outcome demonstrated by an OR of 2.86 [2.07; 3.95; p < 0.001] high heterogeneity [I², 80%; p < 0.001]. Patient with preexisting HF was associated with higher mortality OR of 3.46 [2.52, 4.75; p < 0.001] moderately high heterogeneity [I², 77%; p < 0.001].ConclusionPatients with heart failure are at increased risk for hospitalization, poor outcome, and death from COVID-19. A significant difference in mortality between patients with and without heart failure was observed, patients with heart failure having a higher mortality.     

Effects of yoga on eating disorders—A systematic review

BackgroundThe question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders.MethodsMedline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale.ResultsEight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported.ConclusionsThere is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.     

Do thiazolidinediones cause heart failure? A critical review

Concern has been raised about whether the fluid retention caused by thiazolidinediones (TZDs, ie, rosiglitazone and pioglitazone) can cause or exacerbate congestive heart failure. Although fluid retention is a worrisome side effect of TZDs, current evidence does not link fluid retention caused by TZDs with worsening heart function. TZDs have many benefits for patients with diabetes and can even be used cautiously in patients with mild heart failure, with careful monitoring of volume status.     

Coronary heart disease—A subjective perspective

Heart to Heart is a local ‘Self Help’ group that was formed in April 1986 in Leicester with post coronary patients in mind and also to assist and give support to the families.After a period of some months, and after talking to other like-minded groups, it was recognised that a loose national association would benefit the existing groups and clubs by centralising information and all relevant material regarding C.H.D. and it's attendant aspects.On this premise, Interheart was born in Leicester in April 1987. It has one aim and that is to promote the welfare and care of cardiac patients and their supporters within the community. It's objectives are also simple. 1. To offer practical support and information to new and existing ‘Self Help Groups’. 2. To act, where necessary, as a national voice to raise public awareness to the needs of cardiac patients and their supporters.The Secretary/Coordinator to both groups, Mike Preston, has gained a considerable amount of information on the experience of coronary heart disease (CHD) from his own perspective and that of others who have talked to him. It is felt that this may be useful to nurses who have never experienced the effects of CHD but nurse those who have.     

Are alterations in running biomechanics associated with running injuries? A systematic review with meta-analysis

BackgroundNo systematic review has investigated the main biomechanical variables as predictors of running-related injuries.ObjectiveTo investigate the main biomechanical variables associated with running-related injuries.MethodsMedline via PubMed, EMBASE, SPORTDiscus, Web of Science, and CINAHL were searched from inception until 1 November 2021. Each study included must have investigated the association of at least one biomechanical variable (kinetics, kinematics, electromyography, or pressure distribution) with running injuries. The meta-analysis was conducted, and a modified version of the Downs and Black Quality Index was used for methodological quality evaluation.ResultsAcross the 82 studies included, 5465 runners were investigated. The meta-analysis was conducted with 11 biomechanical variables from 51 articles (n=2395). The peak hip adduction angle was the sole biomechanical variable associated with running injury and was found to be higher in injured runners (0.57, 95% CI 0.21, 0.94) compared to uninjured runners. However, this result was highly influenced by two studies (out of five studies) conducted by the same group of authors.ConclusionClinicians, coaches, and runners should be aware that minimal evidence supports that alterations of running biomechanics are associated with running-related injuries. Heterogeneity in evaluation conditions and inconsistency in the naming and definitions of biomechanical variables make definitive conclusions challenging.Systematic review registration numberPROSPERO, CRD42017068839     

In-silico pelvis and sacroiliac joint motion—A review on published research using numerical analyses

BackgroundComputational models of the human pelvis have become highly useful tools to assess mechanisms of injury, diagnostics and treatment options. The purpose of this systematic literature review was to summarize existing pelvic computer models, to assess their comparability and the measures taken for experimental validation.MethodsResearch on virtual simulations of the posterior pelvis and sacroiliac joint available from the ISI Web of Knowledge, PubMed and Scopus databases available until January 2018 were included.FindingsFrom a total of 3938 articles, 33 studies matched the criteria. Thirteen studies reported on experimental biomechanics, of which seven were parametric. Thirteen studies focused on pelvic injury and surgery, three were clinical case reports. One study assessed the effects of lumbar surgery on the sacroiliac joint, three studies on diagnostics and the non-surgical treatment of the sacroiliac joint. The mode of load application, geometry, material laws and boundary conditions varied vastly between the studies. The majority excluded the lumbosacral transition as part of pelvic biomechanics, and used isotropic linear elastic material properties. Outcomes of the analyses were reported inconsistently with negative impact on their comparability, and validation was commonly conducted by literature with varying agreement of the loading conditions.InterpretationComparability and validation are two major issues of present computational biomechanics of the pelvis. These issues diminish the transferability of the in-silico findings into real-life scenarios. In-vitro cadaveric models remain the realistic standard to account for the present computational analyses which simplify the complex nature of musculoskeletal tissues of the pelvis.     

Is vitamin D deficiency associated with heart failure? A review of current evidence

An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D. Even more alarming is the association of vitamin D deficiency with many types of diseases, particularly heart failure (HF). Hypovitaminosis D has been observed to be highly prevalent in the HF community with rates varying from approximately 80% to 95%. Higher rates of deficiency have been linked to winter months, in patients with protracted decompensated HF, darker skin pigmentation, and higher New York Heart Association (NYHA) classes. In fact, some data suggest vitamin D deficiency may even be an independent predictor of mortality in patients with HF. Traditionally obtained through UV exposure and activated in the liver and then the kidneys, vitamin D is classified as a vitamin but functions as a steroid hormone. The hormone acts through the vitamin D receptor (VDR), which is expressed in vascular smooth muscle cells, renal juxtaglomerular cells, and most interestingly, cardiac myocytes. Studies have shown that the association between vitamin D deficiency and HF often manifests in the structural components of cardiac myocytes and/or through alterations of the neurohormonal cascade. In addition, vitamin D may also act rapidly through intracellular nongenomic receptors that alter cardiac contractility. Unfortunately, prospective vitamin D supplementation trials show mixed results. In rat models, successful correction of deficiency was associated with reductions in ventricular hypertrophy. In humans, however, echocardiographic dimensions did not change significantly. These results bring into questions whether vitamin D is a risk factor for HF, a marker of HF disease severity, or has a true pathologic role. This article provides a thorough review of vitamin D deficiency etiology, prevalence, and possible pathophysiologic role in HF. Furthermore, we carefully review prospective trials on vitamin D therapy in HF. We believe more trials on vitamin D therapy in HF need to be conducted before any conclusions can be drawn.     

How do patients’ values influence heart failure self-care decision-making?: A mixed-methods systematic review

BackgroundValues are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients’ values have in influencing self-care is poorly understood.MethodsA mixed methods systematic review was conducted using a critical meta-narrative synthesis approach to synthesizing qualitative and qualitized data. Nine databases were searched (14 March 2014). To be included in the review, studies had to contain data on heart failure patients’ values and self-care behaviors, include adults aged ≥18 years with symptomatic heart failure, and be published ≥2000 as full articles or theses. Study quality was assessed using a mixed-methods appraisal tool.FindingsOf 6467 citations identified, 54 studies were included (30 qualitative, 8 mixed methods, and 16 quantitative; 6045 patients, 38 lay caregivers, and 96 health care professionals). The synthesis identified multiple bi-directional interactions between heart failure, patients’ values, and self-care. Patients are motivated by self-related and other-related values. Self-related values are tied directly to intimate personal feelings (self-direction, pleasure, and being healthy) or related to individuals’ life circumstances (maintaining a healthy lifestyle and financial balance). Other-related values, which are fundamentally socially-based, are related to benefits received from society (social recognition and socialization) and social obligations (responsibility, observing traditions, and obedience). For each decision, several values are involved; some are incompatible and some are in conflict. Patients make their self-care decision based on the values they prioritize and those that are blocked.ConclusionValues are integral to how patients approach and undertake HF self-care. These values both affect and respond to this self-care and the severity of HF symptoms. Values extend to those relating to the self and others and incorporate a range of personal, life, and social dimensions. Values cannot be assumed to be fixed, normative or similar to those held by nurses and other health professionals. Future interventions to improve HF self-care must address and respond to the complexity of patients’ values and how they influence patient behavior in undertaking heart failure self-care.     

Deformational Plagiocephaly—A Focus on Prevention

Deformational plagiocephaly is a common issue in primary care. It is crucial that providers are familiar with recommendations for the diagnosis and management of DP. In this article we provide an overview of literature related to epidemiology, risk factors, clinical presentation, differential diagnosis, history and physical, diagnostics, management, screening, prevention, and associated delays in development. As deformational plagiocephaly is an avoidable condition, we stress the importance of early screening and present strategies for prevention.     

A novel internal fixation method for open book injuries of the pubic symphysis— A biomechanical analysis

BackgroundPelvic fractures in adults are common injuries and account for up to 3.64% of all fractures. Usually, the treatment of open book injuries (Types B1.1 and B1.2 AO-Classification) is open reduction and plate stabilization using dynamic compression plates, with or without interlocking screws. These implants seem to enhance the outcome of such injuries, but also variety of complications occurs. To reduce complications and achieve appropriate reduction and stabilization, this study compared established stabilization techniques to a novel minimally invasive internal fixation method using an internal fixator system that is already being utilized for spinal fractures.MethodsThis study was performed on 32 composite pelvises in a bilateral stance biomechanical model. The pelvises were variously stabilized with an internal fixator, a 4.5 mm dynamic compression plate and a 3.5 mm symphyseal locking dynamic compression plate. The contact area and loading forces were assessed by a sensor film inside the symphyseal gap.FindingsThis study showed significantly greater reduction and loading capabilities of the internal fixator compared to the other implants (p < 0.05). There was also significantly greater contact area with the use of an internal fixator compared to the other implants (p < 0.05). The 3.5 mm interlocking plate showed significantly greater contact area compared to the 4.5 mm plate (p < 0.05).InterpretationThe internal fixator that is already proven in spinal surgery is biomechanically superior to conventional implants used in pelvic surgery. The contact area analysis furthermore showed a more physiological loading pattern, which can improve ligamentous healing in a clinical context.     

Effects of square-stepping exercise on motor and cognitive function in older adults — A systematic review and meta-analysis

ObjectivesTo document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults.MethodsFive online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function.ResultsTen articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function.ConclusionIn older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.     

Ocular injuries—treat or refer?

Few things in medicine strike such terror in the general physician's heart as does the injured eye, yet the initial management of such an emergency often falls to the nonophthalmologist The physician needs a systematic and simple method for evaluation of eye injuries that makes use of readily available equipment This article provides just such an approach. Indeed, after proper evaluation, many eye injuries can be handled without referral to an ophthalmologist, as the author points out     

Pressure related injuries: A burning issue?

IntroductionTo the majority of health care professionals, burns present as a challenging and potentially distracting diagnosis. Because of their perceived complexity, they often eclipse other medical problems which can often be life threatening. Pressure related injuries, in rare instances can mimic and be mistaken for full thickness burns. Long lies may cause pressure necrosis of decubitus areas and compartment syndrome of vulnerable areas. Compartment syndrome, is a surgical emergency requiring prompt diagnosis and intervention. It may be missed in the context of a long lie after a collapse and maybe detrimental to patients' prognosis.MethodsWe reviewed cases referred to our Burns unit in the last four months to find cases of pressure related injuries referred as burn wounds. Furthermore, we also performed a literature search to find any similar cases to ours.ResultsTwo cases, with acute pressure related injuries from long lies had been mistaken for burn wounds, were referred to our unit in the last four months. In one case a missed compartment syndrome resulted in a below elbow amputation.ConclusionPattern analysis and recognition are very important diagnostic tools in medicine. Detailed history taking and examination cannot be emphasised enough. Training both emergency departments and plastic surgeons in recognising long lie related injuries will decrease possible associated dangers such as missing a compartment syndrome.