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   Table of Contents - Current issue
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July-September 2022
Volume 6 | Issue 3
Page Nos. 99-208

Online since Friday, September 30, 2022

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EDITORIALS  

Sleep, exercise, stress, COVID-19, and human health Highly accessed article p. 99
Lin Lu
DOI:10.4103/hm.hm_40_22  
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Expert consensus on diagnosis and treatment of adult mental stress-induced hypertension in China (2022 Revision): Part B Highly accessed article p. 101
Lin Lu, Qingshan Geng, Jian'an Wang, Chunlin Bai, Gong Cheng, Yinghua Cui, Bo Dong, Jianqun Fang, Feng Gao, Ruowen Huang, Shuwei Huang, Yuming Li, Gang Liu, Yuanyuan Liu, Yan Lu, Yanping Ren, Jialiang Mao, Dazhuo Shi, Huimin Su, Xinyu Sun, Xingguo Sun, Xiangdong Tang, Fengshi Tian, Hong Tu, Hao Wang, Qing Wang, Xiangqun Wang, Junmei Wang, Le Wang, Yibo Wang, Yumei Wang, Zhipeng Wang, Shaojun Wen, Hui Wu, Yanqing Wu, Peng Xiong, Guolong Yu, Ning Yang, Xiaoling Zhao, Haicheng Zhang, Meiyan Liu
DOI:10.4103/hm.hm_16_22  
Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-cardiology Group, College of Cardiovascular Physicians of Chinese Medical Doctor Association, and Hypertension Group of the Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of two parts. The sections of Part A include (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis. The sections of Part B contain (IV) Treatment recommendations, and (V) Prospects. This article presents Part B of the consensus.
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REVIEW ARTICLES Top

Efficacy and safety of traditional chinese medicine combined with western medicine for the treatment of COVID-19: A systematic review and meta-analysis Highly accessed article p. 105
Shanshan Tian, Kai Yuan, Yongbo Zheng, Xuejiao Gao, Xuan Chen, Yingbo Yang, Shiqiu Meng, Lu Cao, Le Shi, Wei Yan, Xiaoxing Liu, Jie Shi, Lin Lu, Jiahui Deng, Yanping Bao
DOI:10.4103/hm.hm_10_22  
Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. Traditional Chinese Medicine (TCM) was considered important by Chinese health authorities in the fight against COVID-19. This review systematically analyzed and evaluated the safety and efficacy of TCM combined with Western Medicine (WM) for the treatment of COVID-19. We sought to provide summary evidence for clinicians when using TCM. We searched for studies in PubMed, Web of Science, Embase, Medline, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data from database inception to June 1, 2021. Overall, 31 studies (14,579 participants) were involved in the final systematic review, including 15 randomized controlled trials and 16 observational studies. TCM combined with WM showed main outcomes of a higher clinical efficacy rate (odds ratio [OR] =2.48, 95% confidence interval [CI] =1.90–3.24, I2 = 4%) and lower case fatality rate (OR = 0.31, 95% CI = 0.19–0.49, I2 = 80%) compared with WM treatment alone. No significant overall adverse events were found between TCM plus WM group and WM group (OR = 1.43, 95% CI = 0.63–2.23, I2 = 75%). Some larger randomized control trials would assist in defining the effect of TCM combined with WM on the treatment of COVID-19 complications such as cardiac injury. TCM combined with WM may be safe and effective for the treatment of COVID-19.
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Impact of Sleep on Cardiovascular Health: A Narrative Review p. 120
Oliver Sum-Ping, Yong-Jian Geng
DOI:10.4103/hm.hm_29_22  
Sleep is a universal biological function but remains poorly understood and a relatively new field of science and medicine. Over the past decade, there have been rapidly accumulating scientific and clinical data around sleep, including the effects of various sleep aspects on cardiovascular health. Much of the research in the field has focused on sleep-disordered breathing, particularly obstructive sleep apnea. However, other sleep pathologies including hypersomnolence disorders, sleep-related movement disorders, and parasomnia disorders have been linked with cardiovascular health. Other areas of sleep, such as sleep duration, timing, and circadian rhythms, also have a demonstrated association with heart health. In this review, we provide an updated summary of the literature connecting sleep and cardiovascular disease.
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A Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere” p. 127
Kyriakos Dimitriadis, Evanthia Bletsa, Emilia Lazarou, Ioannis Leontsinis, Panagiota Stampouloglou, Eirini Dri, Athanasios Sakalidis, Nikolaos Pyrpyris, Panagiotis Tsioufis, Gerasimos Siasos, Dimitrios Tsiachris, Konstantinos Tsioufis
DOI:10.4103/hm.hm_25_22  
Exercise provides beneficial effects on the primary and secondary prevention of numerous chronic conditions, including cardiovascular disease, diabetes mellitus, and malignancies. Despite its indisputable benefits, exercise can rarely trigger major adverse cardiovascular events such as ventricular arr hythmias, myocardial infarction, or even sudden cardiac arrest in susceptible individuals. Physiological changes that occur during exercise, including increased sympathetic activity and cardiac oxygen requirements, may account for ischemia and trigger ventricular ectopy with eventually adverse outcomes. Tailored preparticipation screening for exercise and sports engagement is fundamental to unveiling underlying pathological conditions. The present review summarizes the overall impact of exercise on cardiovascular health and highlights the recommended prevention strategies.
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Exercise, Advanced Glycation End Products, and Their Effects on Cardiovascular Disorders: A Narrative Review p. 139
Saeedeh Hosseini Hooshiar, Helia Esmaili, AmirMohammad Taherian, Sadegh Jafarnejad
DOI:10.4103/hm.hm_31_22  
Lifelong accumulation of advanced glycation end products (AGEs) is linked to cardiovascular disease (CVD). As a result of AGEs, cardiovascular dysfunction develops and progresses via two main mechanisms: cross-linking AGEs with tissue proteins and binding of AGEs to their receptor for AGE (RAGE). In addition, the formation of atherosclerotic plaques in these patients may be due to increased oxidative stress, leading to an elevation in blood circulation and tissue AGEs. Increasing physical activity is a critical approach among the different strategies to manage the deleterious effects of these changes caused by disease. Exercise prevents the accumulation of AGEs and slows the progression of chronic disease sequels. Exercise reduces AGE levels through a reduction of insulin sensitivity, fat mass, inflammation, and RAGE expression. An improvement in glucose metabolism and glycemic control are also other possible explanations. Reduced peripheral insulin resistance may attenuate AGE accumulation. Physical exercise causes more antioxidant enzyme secretion and reduces oxidative stress. Antioxidant and anti-inflammatory endothelial function is improved by exercise. After exercise, subendothelial matrix stiffness decreases, and endothelial function is improved. In this current study, the association between AGEs and exercise and their interaction effects on CVD are discussed.
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The Role of Cortisol in the Development of Post-Stroke Dementia: A Narrative Review p. 151
Isabella Edwards, Indu Singh, Roselyn B Rose'meyer
DOI:10.4103/hm.hm_32_22  
Stroke is defined as a neurological deficit which lasts more than 24 h or leads to death, which is caused by a focal acute injury to the central nervous system with a vascular origin. Strokes are one of the greatest challenges in public health. As an acutely stressful event, strokes have been associated with an increased release in the stress hormone cortisol. Elevated cortisol has been linked to deleterious impacts on the brain, particularly the hippocampus, and has been associated with the development of dementia, though the mechanisms behind this remain unclear. Dementia is also an important stroke outcome, affecting approximately a third of stroke survivors in the long term. This review explores the relationship between strokes and cortisol, to determine the association between cortisol and hippocampal/neuronal damage and poststroke dementia and cortisol.
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ORIGINAL ARTICLES Top

Anti-Inflammation Relieving Heart Dysfunction and Depressive Behaviors of Mice Under Myocardial Infarction and Chronic Stress p. 159
Lijun Zhang, Shuhui Tao, Nan Lu, Ruoyu Pan, Meiyan Liu
DOI:10.4103/hm.hm_9_22  
Background: Myocardial infarction (MI) induces high morbidity all over the world. Patients with MI are more vulnerable to depression, and depression worsens their prognosis. Inflammatory response is the primary pathophysiological mechanism of MI combined with depression. Therefore, MI and depression would benefit from attenuating inflammation. Objectives: To explore the anti-inflammation effect in relieving heart dysfunction and depressive behaviors of mice under MI and chronic stress. Materials and Methods: A total of 40 male C57BL/6J mice were given sham or MI surgery, and the success rate of the surgery was 80%. Hence, 32 mice survived surgery and were distributed as 8 in each group of study. Then, unpredictable chronic mild stress (UCMS) or Anshen Buxin Liuwei pills (ABL pills) group were applied to some MI mice, and the mice were divided into different groups, including sham group, MI group, MI + UCMS group, and MI + UCMS + ABL pills group (n = 8). After a 2-week treatment, the mice underwent the sucrose preference test, and echocardiography before sacrifice. Then, the mice were sacrificed for pathological detection and inflammatory cytokines detection. Results: Compared with mice in the sham group, those mice had lower left ventricular ejection fraction (LVEF) (51.25 ± 9.92 vs. 12.18 ± 8.46, 20.95 ± 16.40, 29.55 ± 13.33%, P < 0.05) and left ventricular fractional shortening (LVFS) (21.12 ± 6.82 vs. 5.57 ± 4.0, 9.89 ± 8.03, 14.0 ± 6.65%, P < 0.05) in the MI, MI + UCMS, and MI + UCMS + ABL pills groups. ABL pills could reverse cardiac dysfunction for the significant elevation of LVEF and LVFS. The hematoxylin and eosin staining presented left ventricular (LV) enlargement, inflammatory cell infiltration, and myocardial fibrosis formation in MI and MI + UCMS mice. While ABL pills reversed the pathological changes induced by ligation of the left anterior descending. The enzyme-linked immunosorbent assay detection showed that MI and MI + UCMS elevated the concentrations of cardiac tumor necrosis factor-α (TNF-α) and tumor necrosis factor receptor 1 (TNFR1), which were reduced by ABL pills. ABL pills significantly reversed the depressive behaviors of mice with MI + UCMS (82.97 ± 3.04 vs. 76.07 ± 7.84%, P < 0.05). MI + UCMS group had a higher level of cortex TNFR1 than sham and MI, while ABL pills reversed the elevation (P > 0.05). Conclusions: Anti-inflammation treatment effectively improves cardiac function and depressive behaviors via inhibiting TNF-α/TNFR1.
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Differences in muscle strength, physical activity, and cardiometabolic risk factors between type 2 diabetic patients with and without benzodiazepines or antipsychotic medications p. 167
Hidetaka Hamasaki
DOI:10.4103/hm.hm_14_22  
Objective: This study aimed to examine differences in muscle strength, physical activity, and cardiometabolic risk factors between Type 2 diabetic patients with and without benzodiazepines (BZD) or antipsychotic drugs (APD). Methods: The author conducted a cross-sectional study on patients with Type 2 diabetes (T2D) whose medication history was collected, and handgrip strength (HGS) was measured. Non-BZD- or APD-users were matched one-to-one with the BZD- or APD-users with respect to their age, gender, and body mass index. The differences in HGS, physical activity, and cardiometabolic risk factors such as blood pressure, lipid profile, and glycemic control between groups were assessed. Results: One hundred and ninety-six patients with and without BZD and 85 patients with and without APD were enrolled. HGS and walking time were significantly lower in patients treated with BZD or APD users than those without BZD or APD. Serum triglycerides levels were higher and high-density lipoprotein cholesterol levels were lower in patients treated with APD than those treated without APD. Both BZD and APD users had a longer sleep duration than nondrug users. Conclusion: BZD and APD were associated with decreased muscle strength and daily physical activity, and APD could impair lipid metabolism in patients with T2D, which may result in increasing the risk of cardiovascular (CV) events. BZDs and APDs should be judiciously prescribed for patients with T2D who are at high risk of CV disease.
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Effects of Perceived Stress with Musculoskeletal Pain in Hong Kong p. 173
Ho Pui Wing, Adrian Low, Joey Lam
DOI:10.4103/hm.hm_20_22  
Objective: Previous psychological research has been made on the role of perceived stress on musculoskeletal pain among adolescents and people working in different job sectors. However, no research has been made on this subject toward the Chinese population and especially the Hong Kong population. Hence, the objective of this research is to evaluate the effects and relationship between perceived stress and musculoskeletal pain and identify the statistical reasoning results of the research through looking into the specific situation in Hong Kong. Methods: In this research, data from Perceived Stress Scale-14 and a self-made pain questionnaire on perceived stress and musculoskeletal pain were collected from the patients of a registered chiropractor in Hong Kong to provide an in-depth study of how musculoskeletal pain correlated with perceived stress and how an individual's mental health would further be affected by both subjects among the Hong Kong population. Results: The findings of the research indicated that perceived stress is correlated with a combination of rather than one type of musculoskeletal pain and there is a significant correlation between one's posture, musculoskeletal pain, and psychological distress. In addition, in terms of the situation in Hong Kong; the working lifestyle and the prevalence of sedentary lifestyle may act as a risk factor on the results related to one's posture being correlated to musculoskeletal pain and perceived stress. Conclusion: It is hoped that this research could enlighten people working in the clinical psychology and chiropractor industries in Hong Kong on the subject of perceived stress and musculoskeletal pain and inform psychology researchers from other countries the situation regarding bodily pain and perceived stress in Hong Kong.
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Neutrophil-to-Lymphocyte Ratio and Outpatient Management of Low-Risk Acute Pulmonary Embolism p. 183
Abdolmohammad Ranhbar, Bahram Sohrabi, Reza Hajizadeh, Mahdi Karimi Shoar, Hadiseh Kavandi, Sahar Ghodratizadeh, Hanieh Sakha, Kamran Mohammadi
DOI:10.4103/hm.hm_20_21  
Purpose: Low-risk pulmonary thromboembolism (PTE) outpatient management has been described recently. The blood neutrophil/lymphocyte ratio (NLR) has been shown to be a useful marker of cardiovascular disease and an independent predictor of cardiac mortality. The predictive value of NLR in predicting mortality of low-risk PTE was evaluated in this study. Materials and Methods: The total of 168 patients with definite pulmonary embolism diagnosed by computed tomography angiography whose on-admission simplified Pulmonary Embolism Severity Index (PESI) score was zero enrolled in this study. The survival rate of patients according to their NLR was evaluated. Results: During 12 months' follow-up period, eight patients (4.7%) died. None of the patients with an NLR of <3.2 died during the follow-up. The median values of NLR in the nonsurvivor and survivor groups were 9.2 ± 3.03 (2–29.5) and 4.69 ± 0.43 (0.8–24.5), respectively. NLR values were significantly higher in nonsurvivors compared to survivors (P = 0.043). Conclusion: This study suggests that patients with zero PESI score and NLR <3.2 could be managed patiently with good results.
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Cardiac Remodeling in Female Athletes with Relation to Sport Discipline and Exercise Dose – A Cardiac Magnetic Resonance Study p. 187
Lukasz A Malek, Barbara Miłosz-Wieczorek, Magdalena Marczak
DOI:10.4103/hm.hm_19_22  
Purpose: To compare chronic cardiac adaptations to exercise at various intensities and in different sports categories of female athletes. Methods: This was a retrospective study including 30 elite female athletes (members of the National Team), 14 amateur female athletes training 3-6 h per week for several years, and 20 inactive female controls who underwent cardiac magnetic resonance. Results: Left and right ventricular end-diastolic volumes (LVEDVI and RVEDVI) differed between all studied groups. They rose from controls to elite athletes, with amateur athletes in-between (for LVEDVI 73 ± 9 vs. 83 ± 6 vs. 95 ± 13 ml/m2, P < 0.001, for RVEDVI 74 ± 7 vs. 84 ± 6 vs. 97 ± 14 ml/m2, P < 0.001, respectively). Left and right atrial areas (LAA and RAA) were larger in amateur and elite athletes than in controls (P < 0.001), but there was no difference between the two athlete groups. The interventricular septal diameter was mildly higher only in elite female athletes (9 ± 1 mm vs. 8 ± 1 mm, P < 0.001). No difference in the above parameters was found between power and endurance athletes. Three athletes presented with benign myocardial fibrosis in the lower left ventricular (LV)-right ventricle junction point. Conclusions: The hearts of female athletes differed from inactive controls. Part of the changes was related to exercise intensity (LVEDVI and RVEDVI, mild LV muscle thickening), but other changes were not (LAA and RAA). There was no difference in the heart chamber size and LV muscle thickness between studied athletes engaging in power and endurance disciplines. There were also no significant myocardial tissue changes observed in both elite and amateur female athletes.
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CASE REPORT Top

The armchair obtuse marginals: Anomalous origin of obtuse marginals from right coronary sinus - A case report p. 192
Debasish Das, Tutan Das, Subhas Pramanik
DOI:10.4103/hm.hm_58_21  
We report a rare case of anomalous origin of obtuse marginals (OMs) from a common trunk arising from the right coronary sinus in an interesting armchair shape in a 52-year-old female presenting with acute inferior wall myocardial infarction. During routine coronary angiography, the origin of the left anterior descending coronary artery was visualized and the origin of the left circumflex (LCX) coronary artery was not visualized with the sign of nonperfused myocardium in the LCX artery territory. Our case is a rare illustration of armchair OMs with nonperfused proximal and middle LCX coronary artery territory.
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PERSPECTIVE Top

COVID-19, Long COVID, and Psychosomatic Manifestations: A Possible Burden on Existing Rheumatology Facilities p. 195
Md Abu Bakar Siddiq, Johannes Jacobus Rasker
DOI:10.4103/hm.hm_63_21  
COVID-19 mainly affects the respiratory system; however, other body parts can also be involved. After resolving the acute stage, long-standing COVID effects can continue to trouble COVID survivors; a term used to describe them is “long COVID” or post-COVID syndrome. Long COVID phenotypes are physical and functional: physical symptoms include persistent dyspnea, chest pain, myalgia, impaired mobility, and arthralgia, whereas fatigue, depression, cognitive impairment, anxiety, posttraumatic stress disorder, insomnia, and somatization are considered the functional aspects. Growing evidence suggests inflammatory rheumatic conditions may develop in COVID-19. COVID-19 further impact patients significantly with inflammatory arthritis (IA), their physical, psychological and social relationships, and their quality of life. Psychiatric COVID long-haulers could overload the existing rheumatology facilities globally, especially in the simultaneous presence of IA and COVID-19. This perspective addresses how psychosomatic manifestations of COVID-19 and “long COVID” burden the present rheumatology facility. We further address treatment options of “long COVID” and future research direction regarding its pathophysiology and “long COVID” psychosomatic illness, especially in the setting of chronic rheumatic diseases.
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SPOTLIGHT Top

Facing sleep and mental health problems in the COVID-19 era: What shall we do? p. 203
Shiqiu Meng, Lin Lu, Kai Yuan, Doris Yang, Icey Zhang
DOI:10.4103/hm.hm_38_22  
In this interview, Prof. Lin Lu introduced ways to improve sleep and relieve stress, influences of sleep on the heart and mental health, essential qualities of psychiatrists, etc. His major viewpoints are: (a) sleep deprivation disrupts physiological functions, (b) prevalence of mental health problems in the general population, health-care workers, and students showed an increasing trend following COVID-19, and (c) it is a tendency for doctors to develop a comprehensive and integrated treatment plan from the physical and mental perspectives.
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BOOK REVIEW Top

Book review of heart disease: It is all in your head, and what to do about it p. 207
Philip Palade, Mahendran Mahadevan
DOI:10.4103/hm.hm_39_22  
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