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  1. Article ; Online: Social determinants and cardiovascular care: A focus on vulnerable populations and the Jamaica experience.

    Madu, Ernest / Mezue, Kenechukwu / Madu, Kristofer

    FASEB bioAdvances

    2021  Volume 3, Issue 4, Page(s) 266–274

    Abstract: The concept of social determinants of health (SDOH) describes the complex interplay of social, economic, cultural, and environmental forces that influence health and illness and result in health inequities in society. In cardiovascular disease (CVD), ... ...

    Abstract The concept of social determinants of health (SDOH) describes the complex interplay of social, economic, cultural, and environmental forces that influence health and illness and result in health inequities in society. In cardiovascular disease (CVD), SDOH play a significant role in contributing to the severe morbidity and mortality that various cardiovascular diseases inflict on our societies. The components of SDOH include wealth/income, employment status, education, social interactions/support, access to medical care (including mental health services), housing, transportation, physical environment (including availability of green space, water/sanitation, air pollution, noise pollution), work environment, access to good nutrition, social and community networks, access to technology and data, exposure to crime/social disorder/violence, exposure to adverse law enforcement/bad governance, and cultural norms. Leveraging reliable SDOH data is critical to addressing healthcare needs of the community. At-risk populations must be connected to the appropriate resources needed to overcome these barriers to access to achieve better health outcomes. This review explores this theme with a focus on several vulnerable populations and offers possible strategies to reduce these inequalities. The Heart Institute of the Caribbean (HIC) was founded in 2005 to improve access to quality medical and cardiovascular services, made available to everyone regardless of their socioeconomic status. HIC has encountered and learned to navigate a myriad structural, institutional, socio-economic, cultural, and behavioral barriers to appropriate CVD care for vulnerable populations in Jamaica and the wider Caribbean. The successes attained and the lessons learned by HIC can be replicated in other nations to address social determinants that impede cardiovascular and medical care in vulnerable populations and may alleviate the access gap in high-quality care in developing countries and in underserved and marginalized communities in developed countries.
    Language English
    Publishing date 2021-02-02
    Publishing country United States
    Document type Journal Article
    ISSN 2573-9832
    ISSN (online) 2573-9832
    DOI 10.1096/fba.2020-00116
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Focused cardiac ultrasound in pregnancy.

    Edwards, Paul / Anyaogu, Chinyere / Mezue, Kenechukwu / Baugh, Dainia / Goha, Ahmed / Egbuche, Obiora / Nunura, Felix / Madu, Ernest

    Journal of investigative medicine : the official publication of the American Federation for Clinical Research

    2023  Volume 71, Issue 2, Page(s) 81–91

    Abstract: Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries ( ... ...

    Abstract Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.
    MeSH term(s) Pregnancy ; Female ; Humans ; Rheumatic Heart Disease ; Echocardiography ; Morbidity ; Prevalence ; Income ; Pregnancy Outcome
    Language English
    Publishing date 2023-01-23
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1217870-6
    ISSN 1708-8267 ; 0009-9279 ; 1081-5589
    ISSN (online) 1708-8267
    ISSN 0009-9279 ; 1081-5589
    DOI 10.1177/10815589221142195
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Off pump surgical epicardial closure of left anterior descending to pulmonary artery fistula.

    Knop, Gustavo L / Madu, Ernest / Tulloch Reid, Edwin / Soliman, Ahmed

    Journal of cardiothoracic surgery

    2020  Volume 15, Issue 1, Page(s) 306

    Abstract: Background: Coronary artery fistulae (CAF) are rare anomalies. Left anterior descending(LAD) to Pulmonary artery (PA) CAF, represent a minority of cases. Large fistulas, create a significant shunt and a "steal phenomenon", and can lead to myocardial ... ...

    Abstract Background: Coronary artery fistulae (CAF) are rare anomalies. Left anterior descending(LAD) to Pulmonary artery (PA) CAF, represent a minority of cases. Large fistulas, create a significant shunt and a "steal phenomenon", and can lead to myocardial ischemia and heart failure (HF) if left untreated.
    Case presentation: We present a 57 years old female with a large LAD to PA fistulae. Given the rare occurrence and the predominance of low shunt of LAD to PA CAF, this case is functionally exceptional in this fistulae variant, causing a significant shunt which resulted in daily cardiac ischemic chest pain. Diagnosis work up included a nuclear stress test, Coronary Angiography and 3-D Coronary Computed Tomography Angiogram (CCTA). Traditionally, surgery has been the main therapy for symptomatic CAF, but transcatheter closure has emerged as a less invasive strategy and is a valuable alternative or even preferable if no associated cardiac conditions are present, provided the anatomical characteristics of the fistulae are appropriate. The surgical approach includes off pump epicardial interruption of the fistula or closure through a cardiac chamber (trans-cameral) or transpulmonary, or epicardial closure using Cardiopulmonary bypass. Caution must be taken in cases of CAF with Coronary Artery (CA) aneurysm in dominant CA, or drainage into the Coronary Sinus, as the possibility of ischemic complications are higher. Due to anatomical considerations and tortuosity of the fistulae, our patient was considered not amenable for percutaneous closure and surgery was opted. Epicardial closure of the fistula was performed on a beating heart, off pump. Outcome was favorable with complete resolution of ischemic symptoms.
    Conclusion: Symptomatic, high shunt CAF must be interrupted. The presence of daily ischemic symptoms in our case report patient, is worth to be remarked. Alternatives for fistulae closure are transcatheter or surgery, depending on anatomic variables and the presence of associated cardiac conditions. Surgical epicardial closure of LAD to PA fistulae variant can be done with very low mortality and morbidity, but other variants with coronary aneurysm, drainage in the coronary sinus or other concomitant cardiac defects, may result in ischemic complications and higher perioperative mortality and worse long- term outcome.
    MeSH term(s) Coronary Angiography ; Coronary Artery Disease/surgery ; Coronary Sinus ; Coronary Vessel Anomalies/surgery ; Coronary Vessels ; Female ; Heart Failure/surgery ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Middle Aged ; Myocardial Ischemia/surgery ; Pulmonary Artery/surgery ; Treatment Outcome ; Vascular Fistula/complications
    Language English
    Publishing date 2020-10-08
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2227224-0
    ISSN 1749-8090 ; 1749-8090
    ISSN (online) 1749-8090
    ISSN 1749-8090
    DOI 10.1186/s13019-020-01329-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: COVID-19 and the heart: An update for clinicians.

    Goha, Ahmed / Mezue, Kenechukwu / Edwards, Paul / Nunura, Felix / Baugh, Dainia / Madu, Ernest

    Clinical cardiology

    2020  Volume 43, Issue 11, Page(s) 1216–1222

    Abstract: SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly ... ...

    Abstract SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Cardiovascular Diseases/therapy ; Cardiovascular Diseases/virology ; Coronavirus Infections/complications ; Coronavirus Infections/therapy ; Humans ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/therapy ; Renin-Angiotensin System/physiology ; Risk Factors ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 391935-3
    ISSN 1932-8737 ; 0160-9289
    ISSN (online) 1932-8737
    ISSN 0160-9289
    DOI 10.1002/clc.23406
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Indigenous people and the COVID-19 pandemic: the tip of an iceberg of social and economic inequities.

    Goha, Ahmed / Mezue, Kenechukwu / Edwards, Paul / Madu, Kristofer / Baugh, Dainia / Tulloch-Reid, Edwin E / Nunura, Felix / Doubeni, Chyke A / Madu, Ernest

    Journal of epidemiology and community health

    2020  Volume 75, Issue 2, Page(s) 207–208

    MeSH term(s) COVID-19/epidemiology ; Disease Outbreaks/prevention & control ; Health Status Disparities ; Humans ; Income ; Indigenous Peoples ; Mortality ; Pandemics ; Poverty ; Social Class ; Social Determinants of Health
    Keywords covid19
    Language English
    Publishing date 2020-10-16
    Publishing country England
    Document type Letter
    ZDB-ID 391868-3
    ISSN 1470-2738 ; 0142-467X ; 0141-7681 ; 0143-005X
    ISSN (online) 1470-2738
    ISSN 0142-467X ; 0141-7681 ; 0143-005X
    DOI 10.1136/jech-2020-214755
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Sub-Saharan Africa Tackles COVID-19: Challenges and Opportunities.

    Mezue, Kenechukwu / Edwards, Paul / Nsofor, Ifeanyi / Goha, Ahmed / Anya, Ike / Madu, Kristofer / Baugh, Dainia / Nunura, Felix / Gaulton, Glen / Madu, Ernest

    Ethnicity & disease

    2020  Volume 30, Issue 4, Page(s) 693–694

    Abstract: As of May 2020, the global COVID-19 pandemic had reached 187 countries with more than 3.7 million confirmed cases and 263,000 deaths. While sub-Saharan Africa (SSA) has not been spared, the extent of disease is currently far less than in Europe or North ... ...

    Abstract As of May 2020, the global COVID-19 pandemic had reached 187 countries with more than 3.7 million confirmed cases and 263,000 deaths. While sub-Saharan Africa (SSA) has not been spared, the extent of disease is currently far less than in Europe or North America leading some to posit that climatic, genetic or other conditions will self-limit disease in this location. Nonetheless, infections in tropical Africa continue to rise at an alarming pace with the potential to soon exceed health resource availability and to exhaust a health care workforce that is already grossly under supported and ill-equipped. This perspective outlines the context of COVID-19 disease in Africa with a focus on the distinctive challenges faced by African nations and a potential best path forward.
    MeSH term(s) Africa South of the Sahara/epidemiology ; Betacoronavirus ; COVID-19 ; Communicable Disease Control/organization & administration ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Health Care Rationing/organization & administration ; Health Services Needs and Demand/trends ; Health Workforce ; Humans ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Resource Allocation ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-09-24
    Publishing country United States
    Document type Editorial
    ZDB-ID 1274267-3
    ISSN 1945-0826 ; 1049-510X
    ISSN (online) 1945-0826
    ISSN 1049-510X
    DOI 10.18865/ed.30.4.693
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: COVID-19 and the heart: An update for clinicians

    Goha, Ahmed / Mezue, Kenechukwu / Edwards, Paul / Nunura, Felix / Baugh, Dainia / Madu, Ernest

    Clin Cardiol

    Abstract: SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly ... ...

    Abstract SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #597780
    Database COVID19

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  8. Article ; Online: COVID ‐19 and the heart

    Goha, Ahmed / Mezue, Kenechukwu / Edwards, Paul / Nunura, Felix / Baugh, Dainia / Madu, Ernest

    Clinical Cardiology ; ISSN 0160-9289 1932-8737

    An update for clinicians

    2020  

    Keywords Cardiology and Cardiovascular Medicine ; General Medicine ; covid19
    Language English
    Publisher Wiley
    Publishing country us
    Document type Article ; Online
    DOI 10.1002/clc.23406
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article: Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey.

    Bremner, Luca / Vitola, Joao / Cerci, Rodrigo / Campisi, Roxana / Araujo Ríos, Raúl / Massardo, Teresa / Gutierrez-Villamil, Claudia / Solis, Felix / Peix, Amalia / Speckter, Herwin / Sanchez Velez, Mayra / Flores, Ana Camila / Madu, Ernest / Alexánderson-Rosas, Erick / Ortellado, José / Morales, Rosanna / Mut, Fernando / Vera, Luisa / Hirschfeld, Cole B /
    Shaw, Leslee J / Williams, Michelle C / Villines, Todd C / Better, Nathan / Dorbala, Sharmila / Karthikeyan, Ganesan / Malkovskiy, Eli / Cohen, Yosef A / Randazzo, Michael / Pascual, Thomas N B / Pynda, Yaroslav / Dondi, Maurizio / Paez, Diana / Einstein, Andrew J

    International journal of cardiology. Heart & vasculature

    2024  Volume 52, Page(s) 101404

    Abstract: Background: The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak.: Methods: The International ... ...

    Abstract Background: The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak.
    Methods: The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic.
    Findings: LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001).
    Conclusions: Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.
    Language English
    Publishing date 2024-04-04
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 2818464-6
    ISSN 2352-9067
    ISSN 2352-9067
    DOI 10.1016/j.ijcha.2024.101404
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Nocturnal Non-dipping Blood Pressure Profile in Black Normotensives Is Associated with Cardiac Target Organ Damage.

    Mezue, Kenechukwu / Isiguzo, Godsent / Madu, Chichi / Nwuruku, Geoffrey / Rangaswami, Janani / Baugh, Dainia / Madu, Ernest

    Ethnicity & disease

    2016  Volume 26, Issue 3, Page(s) 279–284

    Abstract: Purpose: A non-dipping pattern of nocturnal blood pressure in hypertensive patients is an established predictor of cardiovascular risk, especially in Blacks. However, data on non-dipping normotensives and cardiovascular risk in this population is sparse. ...

    Abstract Purpose: A non-dipping pattern of nocturnal blood pressure in hypertensive patients is an established predictor of cardiovascular risk, especially in Blacks. However, data on non-dipping normotensives and cardiovascular risk in this population is sparse. In this study, we aim to determine if a non-dipping profile in a cohort of Black normotensives is associated with cardiac target organ damage.
    Methods: We studied ambulatory blood pressure patterns in 43 normotensive Black patients of Caribbean origin and classified their profiles as dippers (DP) and non-dippers (NDP) based on their nocturnal blood pressure profiles. Cardiac target organ damage was estimated from 2-D echocardiogram.
    Results: The mean age of the cohort was 52 years. Both groups were similar with respect to baseline age, sex, weight, height, body mass index and daytime ambulatory BP. There was a statistically significant difference in nocturnal blood pressure between DP and NDP groups (112 ± 7/64 ± 2 mm Hg vs 117 ± 3/69 ± 2 mm Hg, P=.004). The NDP cohort showed evidence of cardiovascular target damage on echocardiography with a significantly increased relative wall thickness (.35 ± .07 cm vs .42 ± .05 cm, P=.001), left ventricular mass index (95 ± 14 vs 105 ± 14 g/m(2), P=.018) and left atrial volume index (26 ± 3.5 vs. 30 ± 3.4, P=.001). Left ventricular geometry in the non-dippers also showed increased concentric remodeling, concentric and eccentric hypertrophy.
    Conclusions: Our study demonstrates that nocturnal non-dipping of blood pressure in normotensive Blacks of Caribbean origin may be associated with cardiovascular end organ damage thereby providing new surveillance and therapeutic targets.
    MeSH term(s) African Americans ; Aged ; Blood Pressure/physiology ; Blood Pressure Monitoring, Ambulatory ; Cardiovascular System/pathology ; Caribbean Region ; Circadian Rhythm ; Echocardiography ; Female ; Humans ; Hypertension/drug therapy ; Male ; Middle Aged
    Language English
    Publishing date 2016-07-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1274267-3
    ISSN 1945-0826 ; 1049-510X
    ISSN (online) 1945-0826
    ISSN 1049-510X
    DOI 10.18865/ed.26.3.279
    Database MEDical Literature Analysis and Retrieval System OnLINE

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