Jono Paulin

Wellington Hospital

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Tammy Pegg

Nelson Marlborough Institute of Technology

Niamh Berry-Kilgour

Nelson Marlborough Institute of Technology

Alex Psirides

Wellington Hospital

Shruti Rawal

Harvard University

Rajesh Katare

University of Otago

Patrick Manning

Dunedin Public Hospital

E. Munasinghe

University College London

D. Gray Russell

David G. Russell

Cornell University

I. Horta

Instituto Mexicano de Oftalmología IAP

Cooperative Institutions

University of Otago

Dunedin Public Hospital

Instituto Mexicano de Oftalmología IAP

Southern District Health Board

Harvard University

Brigham and Women's Hospital

Imperial College London

National Institutes of Health

Nelson Marlborough Institute of Technology

Southampton General Hospital

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Down-regulation of proangiogenic microRNA-126 and microRNA-132 are early modulators of diabetic cardiac microangiopathy

Cardiovascular Research (2016)

Shruti Rawal Pujika Emani Munasinghe Amol Shindikar Jono Paulin Vicky A. Cameron

Microangiopathy due to endothelial dysfunction is a major contributing factor to the development of diabetes-induced cardiovascular disease (CVD). Dysregulation of endothelial-specific microRNAs (miRs) is correlated with impaired angiogenesis and cell survival. We investigated the profile of two angiomiRs, miR-126, and miR-132, in the plasma of type 2 diabetic individuals without any known history of CVD as well as in the cardiac tissues collected from diabetics undergoing cardiac surgery.The presence of diabetes alone significantly decreased both angiomiRs in the plasma and the myocardium. The down-regulation of angiomiRs was also associated with reduced capillaries and arterioles and increased endothelial cell apoptosis, the hallmark of microangiopathy. Importantly, a time course study in a type 2 diabetic mouse model confirmed that the down-regulation of angiomiRs preceded endothelial apoptosis as well as alterations in the density of the microvasculature. Finally, therapeutic overexpression of both angiomiRs in diabetic aortic rings and human umbilical vein endothelial cells exposed to high glucose (HG) abrogated the deleterious effects of diabetes and HG on cell survival and proliferation and restored their angiogenic potential.These novel findings demonstrate that the down-regulation of angiomiRs is a major underlying mechanism for the development of microangiopathy in diabetic hearts. Therefore, therapeutic restoration of angiomiRs could become a potential approach to combat the cardiovascular complications of diabetes.

Microangiopathy

Endothelial Dysfunction

Diabetic angiopathy

10.1093/cvr/cvw235

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Citations (83)

PP11.002 A survey of New Zealand hospital practitioners: common understanding of CPR definitions and outcomes

Niamh Berry-Kilgour Jono Paulin Alex Psirides Tammy Pegg

Background

Cardiopulmonary resuscitation (CPR) is defined as chest compressions and rescue breaths and is a subset of resuscitation. Championed for the treatment for out-of-hospital cardiac arrest, CPR is now commonplace for in-hospital cardiac arrest (IHCA).

Method

An online survey of staff involved in resuscitation for IHCA sought demographic information, perceptions on the CPR definition, survival rates from IHCA and perceptions in clinical scenarios.

Results

Of 500 complete responses, specialties with representation included emergency medicine (25%), intensive care (14%) and cardiology (12%). Ninety-seven percent of respondents believed that CPR for IHCA included defibrillation, while 57.2% believed it included comprehensive resuscitation. 65% discussed defibrillation in CPR discussions with patients. Forty-eight percent of respondents offered CPR for IHCA with underlying metastatic malignancy, despite 62.4% estimating survival at <5%. In IHCA with severe aortic stenosis, 43% of those who estimated survival to be <10% would offer CPR. In elderly myocardial infarction, 29% would offer defibrillation alone. In refractory arrhythmic IHCA, 69.2% would offer further CPR and defibrillation while 36% would stop therapy and allow natural death.

Conclusion

The common use of CPR in hospital level care reflects the broader definition of resuscitation. Offering CPR in situations with recognized poor outcomes was commonplace. Evidently for cardiology patients a more nuanced process is required. Recapturing the definition of CPR for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to offer some forms of resuscitation as part of restorative treatment without CPR and facilitate the withholding CPR when potentially futile.

10.1136/spcare-2023-acp.79

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Survey of hospital practitioners: common understanding of cardiopulmonary resuscitation definition and outcomes

Internal Medicine Journal (2023)

Niamh Berry-Kilgour Jono Paulin Alex Psirides Tammy Pegg

Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes.This paper aims to describe clinical understanding of the role of in-hospital CPR and perceived outcomes for IHCA.An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do-not-attempt-CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach.Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety-one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training.The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.

10.1111/imj.16046

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Citations (2)

Blood Pressures in a Random Sample of the New Zealand Population

Journal of Cardiovascular Pharmacology (1990)

Edwin R. Nye Jono Paulin D. Gray Russell

Blood pressures (BPs) were measured as part of a health check in a randomly selected sample of the New Zealand population in the Life in New Zealand survey. A total of 1,410 men and 1,605 women over 15 years of age were studied. Measurements were made by trained observers using the Hawksley random zero instrument. Systolic BP (SBP) and diastolic BP (DBP) increased with age in men and women. There were 29% of men and 24% of women over the age of 45 years with BPs over 160/95 mm Hg, of whom 24% of men and 33% of women indicated they were on treatment for hypertension. No regional or urban/rural differences were seen in either SBPs or DBPs. A history of hypertension in the fathers of respondents related to BPs in the highest tertile of SBPs in males, and SBPs in females. The association was not seen between mothers of respondents, except for DBP in women respondents.

10.1097/00005344-199000167-00031

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Blood pressure in a random sample of the New Zealand population.

PubMed (1992)

Nye Er Jono Paulin David G. Russell

Blood pressures were measured as part of a health check in a randomly selected sample of the New Zealand population. One thousand, four hundred and ten men and 1605 women over 15 years were studied. Measurements were made by trained observers using the Hawksley Random Zero instrument. Systolic and diastolic pressures increased with age in men and women. There were 29% of men and 24% of women over the age of 45 with pressures over 160/95 mmHg of whom 24% of men and 33% of women were on treatment for hypertension. Of all subjects 9% of men and 12% of women were on treatment for hypertension. Systolic and diastolic pressures correlated significantly with body mass index, waist/hip ratio and skinfold measurements in men and women. The most significant correlation was with the body mass index. No regional or urban/rural differences were seen in systolic or diastolic pressures. A history of hypertension in the fathers of respondents related to blood pressures in the highest tertile of diastolic blood pressures in males, and systolic pressure of females. The association was not seen between mothers of respondents in respect of diastolic pressure.

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A Survey of New Zealand Hospital Practitioners: Common Understanding of CPR Definitions and Outcomes

Heart Lung and Circulation (2022)

Niamh Berry-Kilgour Jono Paulin Alex Psirides Tammy Pegg

10.1016/j.hlc.2022.05.007

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Citations (1)

Hitting home: men speak about abuse of women partners.

J Leibrich Jono Paulin Ray Ransom

This comprehensive study of attitudes towards the domestic abuse of women in New Zealand was based on a survey of a national representative sample of 2000 men and a follow-up survey of 200 of those 2000 men. In the first study information on mens personal characteristics attitudes towards abuse and abusive behavior were analyzed. The second study explored mens perceptions of the causes of abuse the control of women as an issue and the loss of control of anger issue. Overall it was found that a substantial proportion of New Zealand women were abused by their male partners both physically and psychologically. A mans socioeconomic level educational level and personal income group was insignificant with regard to the likelihood of his being abusive to a woman partner. Moreover the ideas that abuse occurs because of loss of control in anger and that women were to blame for their abuse were arguments which deflect responsibility from a man for his own behavior. Based on the findings study implications underscore the need to alter the existing social expectations of men and the importance of educating men in dealing with stress gaining a sense of self-esteem and managing their anger. Directions for future research are also discussed. This paper also provides appendices which include the methodology additional tables comparative research and the questionnaires.

Blame

Abusive relationship

Psychological abuse

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Citations (48)

Congenital lamellar cataract in family members of an index case.

G. Gascon Jono Paulin Villacis Moran Roberto Velasquez I. Horta

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Circulating cardiovascular microRNAs as diagnostic biomarkers for early diagnosis of diabetic heart disease

Heart Lung and Circulation (2014)

Shruti Rawal Jono Paulin E. Munasinghe Patrick Manning Rajesh Katare

Pathognomonic

10.1016/j.hlc.2014.04.227

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Citations (0)