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ESC Heart Failure May 2024The viability of cardiac resynchronization therapy (CRT) in inotrope-dependent heart failure (HF) has been a matter of debate.
AIMS
The viability of cardiac resynchronization therapy (CRT) in inotrope-dependent heart failure (HF) has been a matter of debate.
METHODS AND RESULTS
We searched Medline, EMBASE, Scopus, and the Cochrane Library until 31 December 2022. Studies were included if (i) HF patients required inotropic support at CRT implantation; (ii) patients were ≥18 years old; and (iii) they provided a clear definition of 'inotrope dependence' or 'inability to wean'. A meta-analysis was performed in R (Version 3.5.1). Nineteen studies comprising 386 inotrope-dependent HF patients who received CRT (mean age 64.4 years, 76.9% male) were included. A large majority survived until discharge at 91.1% [95% confidence interval (CI): 81.2% to 97.6%], 89.3% were weaned off inotropes (95% CI: 77.6% to 97.0%), and mean discharge time post-CRT was 7.8 days (95% CI: 3.9 to 11.7). After 1 year of follow-up, 69.7% survived (95% CI: 58.4% to 79.8%). During follow-up, the mean number of HF hospitalizations was reduced by 1.87 (95% CI: 1.04 to 2.70, P < 0.00001). Post-CRT mean QRS duration was reduced by 29.0 ms (95% CI: -41.3 to 16.7, P < 0.00001), and mean left ventricular ejection fraction increased by 4.8% (95% CI: 3.1% to 6.6%, P < 0.00001). The mean New York Heart Association (NYHA) class post-CRT was 2.7 (95% CI: 2.5 to 3.0), with a pronounced reduction of individuals in NYHA IV (risk ratio = 0.27, 95% CI: 0.18 to 0.41, P < 0.00001). On univariate analysis, there was a higher prevalence of males (85.7% vs. 40%), a history of left bundle branch block (71.4% vs. 30%), and more pronounced left ventricular end-diastolic dilation (274.3 ± 7.2 vs. 225.9 ± 6.1 mL).
CONCLUSIONS
CRT appears to be a viable option for inotrope-dependent HF, with some of these patients seeming more likely to respond.
PubMed: 38710670
DOI: 10.1002/ehf2.14835 -
Clinical Reviews in Allergy & Immunology Apr 2024Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin... (Meta-Analysis)
Meta-Analysis Review
Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine penicillin allergy testing and the (ii) safety of penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low (< 1-3/1000 individuals treated). A subsequent search addressed penicillin allergy delabeling. This found 516 records, and 5 studies addressing the safety of direct oral drug challenge vs. skin testing followed by drug administration in patients with suspected penicillin allergy. Immediate allergic reactions of minor severity were observed for a minority of patients and occurred less frequently in the direct drug challenge group: 2.3% vs. 11.5%; RR = 0.25, 95%CI 0.15-0.45, P < 0.00001, I = 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of penicillin allergy diagnosis or delabeling using direct oral drug challenge or penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.
Topics: Humans; Drug Hypersensitivity; Penicillins; Skin Tests; Practice Guidelines as Topic; World Health Organization; Anti-Bacterial Agents
PubMed: 38696031
DOI: 10.1007/s12016-024-08988-2 -
ZooKeys 2024is the only myriapod of the class Symphyla known from Chile. This garden centipede, or pseudocentipede, was described more than 120 years ago based on morphologically...
is the only myriapod of the class Symphyla known from Chile. This garden centipede, or pseudocentipede, was described more than 120 years ago based on morphologically incomplete specimens collected in central Chile, a well-known biodiversity hotspot. In this study, we redescribe this species based on morphologically complete specimens collected near the type locality using scanning electron microscope images. Our study provides the description of diagnostic characters hitherto unknown in this species such as macrochaetae of the tergites and spinnerets of the cerci. We also include a new record from central Chile and discuss the presumed presence of this species in Argentina and Madagascar.
PubMed: 38693971
DOI: 10.3897/zookeys.1198.119723 -
Europace : European Pacing,... May 2024Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management...
AIMS
Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists.
METHODS AND RESULTS
A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between 4 September and 5 October 2023. Of the 206 respondents, 16% were female and 61% were between 30 and 49 years old. Most of the respondents were EP specialists (81%) working at university hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5-20% LVEF drop). Most respondents considered all available therapies: catheter ablation (93%), electrical cardioversion (83%), antiarrhythmic drugs (76%), and adjuvant HF treatment (76%). A total of 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment, and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day-6 months after antiarrhythmic treatment).
CONCLUSION
This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.
Topics: Humans; Arrhythmias, Cardiac; Female; Male; Cardiomyopathies; Middle Aged; Adult; Europe; Surveys and Questionnaires; Stroke Volume; Health Care Surveys; Anti-Arrhythmia Agents; Practice Patterns, Physicians'; Ventricular Function, Left; Catheter Ablation; Cardiologists
PubMed: 38693772
DOI: 10.1093/europace/euae112 -
BMC Geriatrics May 2024Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care...
BACKGROUND
Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care is one of the barriers to access to treatment. This study was aimed at assessing the attitudes towards seeking psychological help among older adults who are enrolled in primary care in Chile, and to determine the associated factors.
METHODS
This cross-sectional study recruited 233 primary care users aged 65 or more years. The Attitudes Towards Seeking Professional Psychological Help was used. Reliability and factor analysis of this scale were carried out. The average scores of the scale and factors were calculated and compared, by selected variables. Multivariate linear regression was estimated to determine factors associated with attitudes towards seeking psychological help.
RESULTS
Three factors were identified in the attitudes towards seeking psychological help: confidence in psychologists, coping alone with emotional problems, and predisposition to seek psychological help. On average, participants had a favorable attitude towards seeking psychological help, compared with previous research. Lower level of education, and risk of social isolation were inversely associated with these attitudes.
CONCLUSION
Strategies to improve mental health literacy and social connection among older adults, could have an impact on factors that mediate the access to mental health care, such as attitudes towards seeking psychological help, among people who have a lower level of education or are at risk of social isolation.
Topics: Humans; Male; Aged; Female; Chile; Primary Health Care; Cross-Sectional Studies; Patient Acceptance of Health Care; Independent Living; Aged, 80 and over; Attitude to Health
PubMed: 38693485
DOI: 10.1186/s12877-024-04986-3 -
Arthroscopy Techniques Apr 2024Dealing with massive and irreparable rotator cuff tears presents intricate challenges. Concerning elder patients, either conservative management or reverse shoulder...
Dealing with massive and irreparable rotator cuff tears presents intricate challenges. Concerning elder patients, either conservative management or reverse shoulder arthroplasty could be the most appropriate treatment. On the other hand, in younger patients, there is a wide spectrum of solutions, most of them being under evaluation and not completely validated. The complexity increases when a greater tuberosity avulsion occurs at the same time. Regardless of whether surgical fixation is performed, there is a risk for bone resorption, which would result in the posterosuperior cuff's insertion spot loss. In this case, the surgeon is expected to simultaneously manage the bone loss and the tendon tear. The Calcaneum-Achilles Tendon Allograft (CalATA) therefore appears to play an interesting role due to its solid bone-tendon structure. This Technical Note aims to present the CalATA technique, which consists in both tendon and bone deficiency restoration in massive rotator cuff tears with greater tuberosity resorption.
PubMed: 38690347
DOI: 10.1016/j.eats.2024.102919 -
Scientific Reports Apr 2024The edible fungus industry is one of the pillar industries in the Yunnan-Guizhou Plateau, China. The expansion of the planting scale has led to the release of various...
The edible fungus industry is one of the pillar industries in the Yunnan-Guizhou Plateau, China. The expansion of the planting scale has led to the release of various mushroom residues, such as mushroom feet, and other wastes, which are not treated adequately, resulting in environmental pollution. This study investigated the ability of black soldier fly (Hermetia illucens L.) larvae (BSFL) to degrade mushroom waste. Moreover, this study analyzed changes in the intestinal bacterial community and gene expression of BSFL after feeding on mushroom waste. Under identical feeding conditions, the remaining amount of mushroom waste in Pleurotus ostreatus treatment group was reduced by 18.66%, whereas that in Flammulina velutipes treatment group was increased by 31.08%. Regarding gut microbial diversity, compared with wheat bran-treated control group, Dysgonomonas, Providencia, Enterococcus, Pseudochrobactrum, Actinomyces, Morganella, Ochrobactrum, Raoultella, and Ignatzschineria were the most abundant bacteria in the midgut of BSFL in F. velutipes treatment group. Furthermore, Dysgonomonas, Campylobacter, Providencia, Ignatzschineria, Actinomyces, Enterococcus, Morganella, Raoultella, and Pseudochrobactrum were the most abundant bacteria in the midgut of BSFL in P. ostreatus treatment group. Compared with wheat bran-treated control group, 501 upregulated and 285 downregulated genes were identified in F. velutipes treatment group, whereas 211 upregulated and 43 downregulated genes were identified in P. ostreatus treatment group. Using Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses, we identified 14 differentially expressed genes (DEGs) related to amino sugar and nucleotide sugar metabolism in F. velutipes treatment group, followed by 12 DEGs related to protein digestion and absorption. Moreover, in P. ostreatus treatment group, two DEGs were detected for fructose and mannose metabolism, and two were noted for fatty acid metabolism. These results indicate that feeding on edible mushroom waste can alter the intestinal microbial community structure of BSFL; moreover, the larval intestine can generate a corresponding feedback. These changes contribute to the degradation of edible mushroom waste by BSFL and provide a reference for treating edible mushroom waste using BSFL.
Topics: Animals; Gastrointestinal Microbiome; Larva; Pleurotus; Agaricales; Biodegradation, Environmental; Diptera; Flammulina; Bacteria
PubMed: 38688964
DOI: 10.1038/s41598-024-60524-6 -
Frontiers in Psychiatry 2024High-intensity intermittent training has emerged as an option for treating major depressive disorder (MDD). However, short sprint training (sSIT), an efficient HIIT...
BACKGROUND
High-intensity intermittent training has emerged as an option for treating major depressive disorder (MDD). However, short sprint training (sSIT), an efficient HIIT modality, has not been tested yet for this purpose. The sSIT has been proven to induce the same metabolic adaptations, with the advantage of promoting lower muscle fatigue than other HIIT protocols.
METHODS
Seventeen adult women diagnosed with moderate/severe MDD were randomly allocated into a sSIT group (n=9) or a control condition (n=8). The sSIT group completed, over two weeks, six 6-10-min sessions which consisted of 3-12 "all out" sprints of 5 s interspersed with low-intensity recovery of 30-45 s. The week before and after the intervention, both groups were evaluated with the Hamilton Depression Rating Scale of 21-itens (HAM-D21), and for physical fitness and incidental physical activity.
RESULTS
The sSIT group exhibited significant improvements for HAM-D21 scores (24.6±8.2 vs. 16.8±10.1), maximum aerobic power (140±15 vs. 155±15 W), countermovement jump (13.0±3.4 vs. 14.9±3.1 cm), % of body fatness (32.4±4.4 vs. 29.3±3.8%), and 4-days number of steps (13,626±11,309 vs. 16,643±15,371) after the training period when compared to the control group.
CONCLUSION
Less than 1 hour of a sSIT protocol over two weeks have demonstrated to reduce depressive symptoms, while improving aerobic fitness and body composition, and increasing incidental physical activity in a sample of women diagnosed with MDD.
PubMed: 38686128
DOI: 10.3389/fpsyt.2024.1356559 -
Global Heart 2024Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor... (Review)
Review
BACKGROUND
Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor maternal and fetal outcomes and is a significant factor in non-obstetric morbidity. Echocardiography has an emerging role in screening for RHD. We aimed to critically analyse the evidence on the use of echocardiography for screening pregnant women for RHD in high-prevalence areas.
METHODS
We searched MEDLINE and Embase to identify the relevant reports. Two independent reviewers assessed the reports against the eligibility criteria in a double-blind process.
RESULTS
The searches (date: 4 April 2023) identified 432 records for screening. Ten non-controlled observational studies were identified, five using portable or handheld echocardiography, comprising data from 23,166 women. Prevalence of RHD varied across the studies, ranging from 0.4 to 6.6% (I, heterogeneity >90%). Other cardiac abnormalities (e.g., congenital heart disease and left ventricular systolic dysfunction) were also detected <1% to 2% of cases. Certainty of evidence was very low.
CONCLUSION
Echocardiography as part of antenatal care in high-prevalence areas may detect RHD or other cardiac abnormalities in asymptomatic pregnant women, potentially reducing the rates of disease progression and adverse labor-associated outcomes. However, this evidence is affected by the low certainty of evidence, and lack of studies comparing echocardiography versus standard antenatal care.
PROSPECTIVE REGISTRATION
PROSPERO 2022 July 4; CRD42022344081 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344081.
RESEARCH QUESTION
'In areas with a high prevalence of rheumatic heart disease, should handheld echocardiography be added to routine antenatal care?'
Topics: Humans; Rheumatic Heart Disease; Female; Pregnancy; Echocardiography; Prevalence; Pregnancy Complications, Cardiovascular; Ultrasonography, Prenatal; Prenatal Care
PubMed: 38681969
DOI: 10.5334/gh.1318 -
Antibiotics (Basel, Switzerland) Apr 2024The hospital environment is increasingly becoming an important reservoir for multi-drug-resistant (MDR) Gram-negative bacteria, posing serious challenges to efforts to...
The hospital environment is increasingly becoming an important reservoir for multi-drug-resistant (MDR) Gram-negative bacteria, posing serious challenges to efforts to combat antimicrobial resistance (AMR). This study aimed to investigate the role of hospital waste as a potential source of MDR ESBL-producing bacteria. Samples were collected from multiple sources within a hospital and its vicinity, including surface swabs, houseflies, and sewage samples. The samples were subsequently processed in a microbiology laboratory to identify potential pathogenic bacteria and confirmed using MALDI-TOF MS. Bacteria were isolated from 87% of samples, with the predominant isolates being (30.5%), spp. (12.4%), spp. (12.4%), and spp. (11.9%). According to the double disc synergy test (DDST) analysis, nearly half (49.2%) of the bacteria were identified as ESBL producers. However, despite exhibiting complete resistance to beta-lactam antibiotics, 11.8% of them did not test positive for ESBL production. The characterization of revealed that 30.6% and 5.6% of them carried CTX-M group 1 type-15 and NDM genes, respectively. This finding emphasizes the importance of proper hospital sanitation and waste management practices to mitigate the spread of AMR within the healthcare setting and safeguard the health of both patients and the wider community.
PubMed: 38667050
DOI: 10.3390/antibiotics13040374