Cardiology Research

Resumen En este artículo de revisión, examinamos el papel de la mitocondria en el buen funcionamiento del corazón, y en la generación de diversas afec-ciones cardíacas, las cuales están caracterizadas por una baja producción de energía por parte de las mitocondrias y, por ende, hay un aumento en la pérdida de cardiomiocitos que conlleva al mal funcionamiento del cora-zón. Se ha determinado, que ciertas disfunciones mitocondriales asociadas a trastornos cardíacos se relacionan con alteraciones del sistema de fos-forilación oxidativa, así como, con la disminución de ciertos componentes estructurales como la cardiolipina y la formación de supercomplejos. Se estima que cerca del 2.3 % de la población colombiana puede presentar una prevalencia a la falla cardíaca. La presente revisión tiene como objeti-vo dar a conocer los avances investigativos relacionados con enfermedades cardíacas ocasionadas por disfunción mitocondrial, así como, la identifica-ción de diferentes investigaciones dirigidas en la creación de alternativas de tratamiento para dichas patologías, todo esto con el fin de contribuir

"Background

Those with advanced heart failure (HF) experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care.

Methods

Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30), carers (n = 20), and professionals (n = 65). Data analysed using Normalisation Process Theory (NPT) as the underpinning conceptual framework.

Findings

Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom.

Conclusions

Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by simple organisational rather than complex clinical mechanisms."

ABSTRACT
Objective To study the prevalence of rheumatic heart
disease (RHD) in schools (locally referred to as ‘daaras’)
located in the city of Dakar and its suburbs using both
clinical examination and echocardiography.
Methods This is a cross-sectional study conducted
from 9 August to 24 December 2011 involving 2019
pupils, aged between 5 and 18 years selected from the
16 ‘daaras’ of the Academic Inspectorate (Inspection
d’Académie) of the city of Dakar and its suburbs.
Anamnestic, clinical and echocardiographic data were
collected and entered into a questionnaire designed for
the study. The World Heart Federation criteria for
echocardiographic diagnosis were used to diagnose
RHD. p<0.05 was considered statistically significant in
bivariate analysis.
Results About 60.1% of the pupils were men and the
mean age was 9.7±3.3 years. 10 cases of definite RHD
were detected, prevalence being 4.96 per 1000 (95% CI
2.4 to 9.1). This prevalence was five times higher with
echocardiographic screening compared with clinical
screening. 23 cases (11.4 per 1000) of borderline forms
were detected. The populations at risk of definite RHD
identified in our study were children over 14 years
(p<0.001), those with recurrent sore throat ( p=0.003)
and those residing in the suburbs of the city of Dakar
(p<0.001).
Conclusion Our study shows a relatively high
prevalence of RHD. Reducing its prevalence should focus
on the implementation of appropriate policies, targeting
at-risk populations and focusing on raising awareness
and early detection.