Embedded AI-Based Digi-Healthcare

Healthcare is an indispensable part of human life and chronic illnesses like cardiovascular diseases (CVD) have a deeply negative impact on the healthcare sector. Since the ever-growing population of chronic patients cannot be managed at hospitals, therefore, there is an urgent need for periodic monitoring of vital parameters and apposite treatment of these patients. In this paper, an Internet of Medical Things (IoMT) -based remote patient monitoring system is proposed which is based on Artificial Intelligence (AI) and edge computing. The primary focus of this paper is to develop an embedded prototype that can be used for remote monitoring of cardiovascular patients. The system will continuously monitor physiological parameters like body temperature, heart rate, and blood oxygen saturation, and then report the health status to the authenticated users. The system employs edge computing to perform multiple functionalities including health status inference using a Machine Learning (ML) model which makes predictions on real-time data, alert notifications in case of an emergency, and transferring data between the sensor network and the cloud. A web-based application is developed for the depiction of raw data and ML results and to provide a direct communication channel between the patient and the doctor. The ML module achieved an accuracy of 96.26% on the test set using the K-Nearest Neighbors (KNNs) algorithm. This solution aims to address the sense of emergency due to the alarming statistics that highlight the mortality rate of cardiovascular patients. The project will enable a smart option based on IoT and ML to improve standards of living and prove crucial in saving human lives.

Anxiety in cardiology. The use of pregabalin in the treatment of anxiety disorders in patients with cardiovascular diseases

The paper discusses two issues: the multidirectional relationship between the occurrence of anxiety symptoms and cardiovascular diseases, and the influence of the persistently high level of anxiety on the course of cardiological diseases and patient prognosis. In the discussion on the negative health consequences of anxiety disorders, there is emphasized importance of early diagnosis of these disorders and implementation of its treatment. As a starting point there were presented clinical cases of cardiovascular patients in whom developed anxiety disorders. The following sections discuss various aspects of the pharmacological treatment of anxiety disorders, focusing on the possible use of pregabalin in this.

Beta-blocker and calcium-channel blocker therapy in patients with cardiovascular pathologies during post-COVID period

С начала 2020 г. в мире распространилась инфекция, вызванная вирусом SARS-CoV-2, что в дальнейшем привело к пандемии COVID-19. Долгое время вопросы ведения пациентов с новой коронавирусной инфекцией в остром периоде рассматривались как первоочередные. По мере накопления клинического опыта и данных о возбудителе новой коронавирусной инфекции стало очевидно, что проблема последствий перенесенного COVID-19 и ведения пациентов на постгоспитальном этапе является такой же важной. В силу прямой и опосредованной кардиотоксичности вируса SARS-CoV-2 особую группу риска на всех этапах составляют пациенты с сердечно-сосудистыми заболеваниями. Поэтому одной из важных задач мирового медицинского сообщества стала разработка способов улучшения качества и прогноза жизни пациентов с сердечно-сосудистыми заболеваниями в постковидном периоде. В статье сделан обзор наиболее крупных исследований, включая данные регистра «Анализ динамики коморбидных заболеваний пациентов, перенесших инфицирование SARS-CoV-2 (AКТИВ SARS-CoV-2)», по вопросу медикаментозной терапии пациентов с сердечно-сосудистыми заболеваниями с акцентом на бета-адреноблокаторы и блокаторы кальциевых каналов. В представленных работах терапия бета-адреноблокаторами продемонстрировала благоприятное влияние на тяжесть течения новой коронавирусной инфекции у пациентов с сердечно-сосудистыми заболеваниями, снижение смертности на госпитальном и в отдаленном постгоспитальном периодах. Данные по применению блокаторов кальциевых каналов изучены в меньшей степени, но можно отметить, что данная группа препаратов является одной из самых часто назначаемых в терапии пациентов с сохранением стойких жалоб на повышение артериального давления на постгоспитальном этапе. Требуется дальнейшее изучение влияния отдельных классов антигипертензивных препаратов на прогноз пациентов с сердечно-сосудистыми заболеваниями и COVID-19. Early in 2020, the infection caused by SARS-CoV-2 emerged and caused the COVID-19 pandemic. For a long time, management of patients with the acute novel coronavirus infection was of primary importance. With accumulation of clinical information and data on the causative agents of novel coronavirus infection it became obvious that the COVID-19 consequences and post-hospital follow-up of patients are important as well. Due to the direct and mediated cardiac toxicity of SARS-CoV-2 virus, cardiovascular patients are at high risk at any stage of the disease. Therefore, one of the priorities for healthcare professionals is development of the ways to improve the quality and prognosis of life for cardiovascular patients in the post-COVID period. The article discusses large-scale studies including the data from the International Register «Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients» (AСTIV-SARS-CoV-2), as regards drug therapy of cardiovascular patients with a focus on beta-blockers and calcium-channel blockers. In mentioned publications, beta-blocker therapy demonstrated favourable impact on the novel coronavirus infection severity in cardiovascular patients, reduction in mortality rates during the hospital and post-hospital periods. Data on the use of calcium-channel blockers have been studied to a lesser extent; however, calcium-channel blockers are thought to be one of the most commonly prescribed groups in the therapy of patients with persistent complaints of high blood pressure at the post-hospital period. A study of the impact of some categories of antihypertensives on the outcome for cardiovascular patients with COVID-19 is warranted.

Reproducibility and its confounders of CMR feature tracking myocardial strain analysis in patients with suspected myocarditis

Objectives Cardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique for assessing myocardial strain with valuable diagnostic and prognostic potential. However, the reproducibility of biventricular CMR-FT analysis in a large cardiovascular population has not been assessed. Also, evidence of confounders impacting reader reproducibility for CMR-FT in patients is unknown and currently limits the clinical implementation of this technique. Methods From a dual-center database of patients referred to CMR for suspected myocarditis, 125 patients were randomly selected to undergo biventricular CMR-FT analysis for 2-dimensional systolic and diastolic measures, with additional 3-dimensional analysis for the left ventricle. All image analysis was replicated by a single reader and by a second reader for intra- and inter-reader analysis (Circle Cardiovascular Imaging). Reliability was tested with intraclass correlation (ICC) tests, and the impact of imaging confounders on agreement was assessed through multivariable analysis. Results Left and right ventricular ejection fractions were reduced in 34% and 37% of the patients, respectively. Good to excellent reliability was shown for 2D (all ICC > 0.85) and 3D (all ICC > 0.70) peak strain and early diastolic strain rate for both ventricles in longitudinal orientation as well as circumferential orientations for the left ventricle. An increased slice number improved agreement while the presence of pericardial effusion compromised diastolic strain rate agreement, and arrhythmia compromised right ventricular agreement. Conclusion In a large clinical cohort, we could show CMR-FT yields excellent inter-reader and intra-reader reproducibility. Multi-parametric CMR-FT of the right and left ventricles appears to be a robust tool in cardiovascular patients referred to CMR. Clinical trial registration. ClinicalTrials.gov Identifier: NCT03470571, NCT04774549. Key Points • Cardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique to measure myocardial strain in cardiovascular patients referred for CMR; however, the evaluation of its reproducibility in a large cohort has not yet been performed. • In a large clinical cohort, CMR-FT yields excellent inter-reader and intra-reader reproducibility for both left and right ventricular systolic and diastolic parameters. • Arrhythmia and pericardial effusion compromise agreement of select FT parameters, but poor ejection fraction does not.

Effect of depression and anxiety on quality of life among cardiovascular patients visiting Tertiary Care hospital Lahore

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Mental disorders like anxiety and depression are common among cardiovascular patients. These mental disorders have adverse effect on quality of life (QoL) among these patients which further increases mortality and morbidity among them Objective: The propose of this study was to assess the effect of anxiety and depression on quality of life among cardiovascular patients Methods: A cross sectional study was performed at Sir Ganga Ram Hospital Lahore. 100 patients of CVD were selected by non-probability sampling technique. All patients of both genders aged above 18 years with diagnosed CVD were included. In order to measure the anxiety and depression among cardiovascular patients, Hospital Anxiety and Depression Scale (HADS) and WHOQOL was used to assess the QoL of patients Results: Out of total 100 patients, there were 47 females and 53 males. Patients mean age was 54.87 ± 16.66. Among CVD patients, 52 were borderline cases and 33 were abnormal cases of anxiety. 56 cases were borderline and 28 were abnormal cases of depression. Anxiety and depression had adverse effect on QoL among CVD patients. Low scores were found for physical, psychological and environmental domains of WHOQOL. A significant association was found between social relationships domain of WHOQOL with anxiety and depression and the level of significance was p-values 0.016 and 0.043 respectively. There was significant association between psychological domain of QoL with depression (P=0.039) and monthly income (P=0.016). There was insignificant association between educational level, sex, age with QoL, anxiety and depression Conclusions: Study concluded that anxiety and depression have negative impact on QoL and are risk factors for health-related QoL among CVD patients. Persons attending medical care are usually not being assessed for anxiety due to lack of facilities, lack of understanding of disease and over burden of patients. They are responsible for greater mortality and morbidity in CVDs. The depression and Anxiety are the mediating factors and it must be taken into consideration in clinical practices when QoL is considered as a clinical prerequisite

The Role of Perceived Social Support on Quality of Life in Patients with Cardiovascular Diseases in Iran: A Cross-Sectional Study

Background: Cardiovascular disease significantly impairs quality of life. Inadequate social support has been associated with poor quality of life in patients with Cardiovascular. The aim of this study was to describe social support and explore its association with quality of life among cardiovascular patients.Methods: This cross sectional study was conducted in 2020 from September to January. We selected 150 cardiovascular patients through convenience sampling. The structured questionnaires included: the Persian version of the WHOQOL-BREF was used to obtain the necessary data on the quality of life, psychometric evaluation of the interpersonal support evaluation list–short form as well as demographic variables were included in each questionnaire. Hierarchical linear regression models were used to explore the association between perceived social support and quality of life.Results: The demographic variables were able to predict 12.2% of the variance of quality of life in the first step. In the second step, after adjusting control variables, dimensions of social support the predictability increased to 29% of the variance with the addition of variables. All dimensions of social support, excluding tangible assets support, were significant predictors of quality of life in addition to monthly income status. Self-esteem support (β= 0.387) was the higher level of predictor of quality of life in cardiovascular patients.Conclusion: Overall, the current study revealed that social support is one of the strategies that cardiovascular patients can utilize to improve their quality of life and overcome their disease. It is possible to say that enhancing social support in patients improves their health and quality of life.

C/EBPδ-induced epigenetic changes control the dynamic gene transcription of S100A8 and S100A9

The proinflammatory alarmins S100A8 and S100A9 are among the most abundant proteins in neutrophils and monocytes but completely silenced after differentiation to macrophages. The molecular mechanisms of the extraordinarily dynamic transcriptional regulation of s100a8 and s100a9 genes, however, are only barely understood. Using an unbiased genome-wide CRISPR/Cas9 knockout based screening approach in immortalized murine monocytes we identified the transcription factor C/EBPδ as a central regulator of S100A8 and S100A9 expression. S100a8 and S100a9 expression was further controlled by the C/EBPδ-antagonists ATF3 and FBXW7. We confirmed the clinical relevance of this regulatory network in subpopulations of human monocytes in a clinical cohort of cardiovascular patients. Moreover, we identified specific C/EBPδ-binding sites within s100a8 and s100a9 promoter regions, and demonstrated that C/EBPδ-dependent JMJD3-mediated demethylation of H3K27me3 is indispensable for their expression. Overall, our work uncovered C/EBPδ as a novel regulator of S100A8 and S100A9 expression. Therefore, C/EBPδ represents a promising target for modulation of inflammatory conditions that are characterised by S100A8 and S100A9 overexpression.

428 The role of virtual visits in COVID-19 cardiovascular patients

Aims The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic forced a reorganization of the healthcare system. In order to prevent potential risk of exposure, virtual visit (VV) has been implemented in the treatment and follow-up of COVID-19 patients with cardiovascular diseases. The aim of this study is to evaluate the feasibility and efficacy of VV in the management of post COVID-19 cardiovascular patients. Methods and results We enrolled all patients with cardiovascular comorbidities tested negative for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) and discharged from our Cardiology Department from January 2021 to June 2021. We scheduled a VV after 30 days from discharge to check the clinical status of the patients, optimize therapy, and establish a Follow-up protocol. Blood pressure, arterial oxygen saturation, heart rate and body weight were registered. To evaluate the patients’ satisfaction of VV, a questionnaire was administered. We performed 25 VVs in the study period; the mean age of patients was 67.5 ± 15.6 and male were 15 (65.2%). The mean duration of VV was 25.9 ± 4.6 min. The caregiver had an active role in nine (36%) cases. No urgent/emergent in-person examinations were performed. A high degree of patient satisfaction was reached and VV was preferred to in-person evaluation. Conclusions VV visit was useful to Follow-up post COVID-19 cardiovascular patients. A high degree of patient satisfaction was reached without jeopardizing quality of care.

A novel approach to educate hospitalized cardiovascular disease patients about lifestyle and behavior modifications

Background Cardiovascular diseases (CVDs) are always considered by healthcare specialists for different reasons, including extensive prevalence, increased costs, chronicity, and high risk of death. The control of CVDs is highly influenced by behavior and lifestyle and it seems necessary to train special abilities about lifestyle and behavior modification to improve self-care skills for patients, and their caregivers. As a result, the development of effective training systems should be considered by healthcare specialists. Methods Hence, in this study, a framework for improving cardiovascular patients’ education processes is presented. Initially, an existing training system for cardiovascular patients is reviewed. Using field observations and targeted interviews with hospital experts, all components of its educating processes are identified, and their process maps are drawn up. After that, challenges in the training system are extracted with the aid of in-depth semi-structured interviews with experts. Due to the importance and different influence of the identified challenges, they are prioritized using a Multiple Criteria Decision-making (MCDM) method, and then their root causes were investigated. Finally, a novel framework is proposed and evaluated with hospital experts' help to improve the main challenges. Results The most important challenges included high nursing workload and shortage of time, lack of understanding of training concepts by patients, lack of attention to training, disruption of the training processes by the patients’ caregivers, and patient's weakness in understanding the standard language. In identifying the root causes, learner, educator, and educational tools are the most effective in the training process; therefore, the improvement scenarios were designed accordingly in the proposed framework. Conclusions Our study indicated that presenting a framework with applying different quantitative and qualitative methods has great potential to improve the processes of patient education for chronic diseases such as cardiovascular disease.