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European Heart Journal Jun 2024Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology...
Acute ST-elevation myocardial infarction (STEMI) and acute ischaemic stroke (AIS) share a number of similarities. However, important differences in pathophysiology demand a disease-tailored approach. In both conditions, fast treatment plays a crucial role as ischaemia and eventually infarction develop rapidly. Furthermore, in both fields, the introduction of fibrinolytic treatments historically preceded the implementation of endovascular techniques. However, in contrast to STEMI, only a minority of AIS patients will eventually be considered eligible for reperfusion treatment. Non-invasive cerebral imaging always precedes cerebral angiography and thrombectomy, whereas coronary angiography is not routinely preceded by non-invasive cardiac imaging in patients with STEMI. In the late or unknown time window, the presence of specific patterns on brain imaging may help identify AIS patients who benefit most from reperfusion treatment. For STEMI, a uniform time window for reperfusion up to 12 h after symptom onset, based on old placebo-controlled trials, is still recommended in guidelines and generally applied. Bridging fibrinolysis preceding endovascular treatment still remains the mainstay of reperfusion treatment in AIS, while primary percutaneous coronary intervention is the strategy of choice in STEMI. Shortening ischaemic times by fine-tuning collaboration networks between ambulances, community hospitals, and tertiary care hospitals, optimizing bridging fibrinolysis, and reducing ischaemia-reperfusion injury are important topics for further research. The aim of this review is to provide insights into the common as well as diverging pathophysiology behind current reperfusion strategies and to explore new ways to enhance their clinical benefit.
PubMed: 38941344
DOI: 10.1093/eurheartj/ehae371 -
PloS One 2024Spinal cord injury (SCI) is a consequence of significant disability and health issues globally, and long COVID represents the symptoms of neuro-musculoskeletal,...
BACKGROUND
Spinal cord injury (SCI) is a consequence of significant disability and health issues globally, and long COVID represents the symptoms of neuro-musculoskeletal, cardiovascular and respiratory complications.
PURPOSE
This study aimed to identify the symptom responses and disease burden of long COVID in individuals with spinal cord injury.
METHODS
This case-control study was conducted on patients with SCI residing at a specialised rehabilitation centre in Bangladesh. Forty patients with SCI with and without long COVID symptoms (LCS) were enrolled in this study at a 1:1 ratio according to WHO criteria.
RESULT
Twelve LCS were observed in patients with SCI, including fatigue, musculoskeletal pain, memory loss, headache, respiratory problems, anxiety, depression, insomnia, problem in ADL problem in work, palpitation, and weakness. The predictors of developing long COVID include increasing age (p<0.002), increasing BMI (p<0.03), and longer duration of spinal cord injury (p<0.004). A significant difference (p<0.01) in overall years of healthy life lost due to disability (YLD) for non-long COVID cases was 2.04±0.596 compared to long COVID (LC) cases 1.22±2.09 was observed.
CONCLUSION
Bangladeshi patients of SCI presented 12 long COVID symptoms and have a significant disease burden compared to non long COVID cases.
Topics: Humans; Spinal Cord Injuries; Male; Female; COVID-19; Case-Control Studies; Adult; Middle Aged; Bangladesh; Disabled Persons; SARS-CoV-2; Post-Acute COVID-19 Syndrome
PubMed: 38941308
DOI: 10.1371/journal.pone.0304824 -
Journal of Primary Health Care Jun 2024Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences...
Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.
Topics: Humans; Native Hawaiian or Other Pacific Islander; Male; Female; New Zealand; Middle Aged; Emergency Medical Services; Qualitative Research; Adult; Cultural Competency; Health Services Accessibility; Allied Health Personnel; Interviews as Topic; Aged; Cardiovascular Diseases; Paramedics; Maori People
PubMed: 38941254
DOI: 10.1071/HC24010 -
The Journal of Clinical Endocrinology... Jun 2024Selye described stress as a unified neurohormonal mechanism maintaining homeostasis. Acute stress system activation is adaptive through neurocognitive,...
Selye described stress as a unified neurohormonal mechanism maintaining homeostasis. Acute stress system activation is adaptive through neurocognitive, catecholaminergic, and immunomodulation mechanisms, followed by a reset via cortisol. Stress system components, the sympathoadrenomedullary system, hypothalamic-pituitary-adrenal axis, and limbic structures are implicated in many chronic diseases by establishing an altered homeostatic state, allostasis. Consequent "primary stress system disorders" were popularly accepted, with phenotypes based on conditions such as Cushing syndrome, pheochromocytoma, and adrenal insufficiency. Cardiometabolic and major depressive disorders are candidates for hypercortisolemic etiology, contrasting the "hypocortisolemic symptom triad" of stress sensitivity, chronic fatigue, and pain. However, acceptance of chronic stress etiology requires cause-and-effect associations, and practical utility such as therapeutics altering stress system function. Inherent predispositions to stress system perturbations may be relevant. Glucocorticoid receptor (GR) variants have been associated with metabolic/neuropsychological states. The SERPINA6 gene encoding corticosteroid-binding globulin (CBG), was the sole genetic factor in a single-nucleotide variation-genome-wide association study linkage study of morning plasma cortisol, a risk factor for cardiovascular disease, with alterations in tissue-specific GR-related gene expression. Studies showed genetically predicted high cortisol concentrations are associated with hypertension and anxiety, and low CBG concentrations/binding affinity, with the hypocortisolemic triad. Acquired CBG deficiency in septic shock results in 3-fold higher mortality when hydrocortisone administration produces equivocal results, consistent with CBG's role in spatiotemporal cortisol delivery. We propose some stress system disorders result from constitutional stress system variants rather than stressors themselves. Altered CBG:cortisol buffering may influence interstitial cortisol ultradian surges leading to pathological tissue effects, an example of stress system variants contributing to stress-related disorders.
PubMed: 38941154
DOI: 10.1210/clinem/dgae412 -
JAMA Network Open Jun 2024While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper...
IMPORTANCE
While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper limit of normal (reference range) at presentation, early imaging is often used for confirmation. A prior prediction model and corresponding point-based score were developed using nonimaging parameters to diagnose AP in patients presenting to the emergency department (ED).
OBJECTIVE
To evaluate the performance of the prediction model to diagnose AP in a prospective patient cohort.
DESIGN, SETTING, AND PARTICIPANTS
This prospective diagnostic study included consecutive adult patients presenting to the ED between January 1, 2020, and March 9, 2021, at 2 large academic medical centers in the northeastern US with serum lipase levels at least 3 times the upper limit of normal. Patients transferred from outside institutions or with malignant disease and established intra-abdominal metastases, acute trauma, or altered mentation were excluded. Data were analyzed from October 15 to October 23, 2023.
EXPOSURES
Participants were assigned scores for initial serum lipase level, number of prior AP episodes, prior cholelithiasis, abdominal surgery within 2 months, presence of epigastric pain, pain of worsening severity, duration from pain onset to presentation, and pain level at ED presentation.
MAIN OUTCOME AND MEASURES
A final diagnosis of AP, established by expert review of hospitalization records.
RESULTS
Prospective scores in 349 participants (mean [SD] age, 53.0 [18.8] years; 184 women [52.7%]; 66 Black [18.9%]; 199 White [57.0%]) demonstrated an area under the receiver operating characteristics curve of 0.91. A score of at least 6 points achieved highest accuracy (F score, 82.0), corresponding to a sensitivity of 81.5%, specificity of 85.9%, positive predictive value of 82.6%, and negative predictive value of 85.1% for AP diagnosis. Early computed tomography or magnetic resonance imaging was performed more often in participants predicted to have AP (116 of 155 [74.8%] with a score ≥6 vs 111 of 194 [57.2%] with a score <6; P < .001). Early imaging revealed an alternative diagnosis in 8 of 116 participants (6.9%) with scores of at least 6 points, 1 of 93 (1.1%) with scores of at least 7 points, and 1 of 73 (1.4%) with scores of at least 8 points.
CONCLUSIONS AND RELEVANCE
In this multicenter diagnostic study, the prediction model demonstrated excellent AP diagnostic accuracy. Its application may be used to avoid unnecessary confirmatory imaging.
Topics: Humans; Pancreatitis; Female; Male; Prospective Studies; Middle Aged; Adult; Lipase; Emergency Service, Hospital; Aged; Predictive Value of Tests; Acute Disease; Abdominal Pain
PubMed: 38941094
DOI: 10.1001/jamanetworkopen.2024.19014 -
Methods in Molecular Biology (Clifton,... 2024The upper respiratory tract (URT) is home to a diverse range of microbial species. Respiratory infections disturb the microbial flora in the URT, putting people at risk...
The upper respiratory tract (URT) is home to a diverse range of microbial species. Respiratory infections disturb the microbial flora in the URT, putting people at risk of secondary infections. The potential dangers and clinical effects of bacterial and fungal coinfections with SARS-CoV-2 support the need to investigate the microbiome of the URT using clinical samples. Mass spectrometry (MS)-based metaproteomics analysis of microbial proteins is a novel approach to comprehensively assess the clinical specimens with complex microbial makeup. The coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2) is responsible for the COVID-19 pandemic resulting in a plethora of microbial coinfections impeding therapy, prognosis, and overall disease management. In this chapter, the corresponding workflows for MS-based shotgun proteomics and metaproteomic analysis are illustrated.
Topics: Humans; COVID-19; Proteomics; Coinfection; SARS-CoV-2; Microbiota; Respiratory Tract Infections; Mass Spectrometry; Proteome; Respiratory System
PubMed: 38941023
DOI: 10.1007/978-1-0716-3910-8_15 -
Pediatric Cardiology Jun 2024Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to...
Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to long-term outcomes are limited. The aim of this study was to evaluate the mid-term safety and efficacy of transcatheter CoA stenting based on centrally adjudicated outcomes. This retrospective cohort study included patients aged 15 years or younger undergoing de novo stenting for CoA or recoarctation (reCoA) between 2006 and 2017. Immediate and 5-year outcomes were assessed. Immediate outcomes (procedural and in-hospital) were retrieved from electronic records. Rates of 5-year reCoA, stent fractures, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were mid-term outcomes. The study included 274 patients (64% male and 36% female) with a median (interquartile range) age of 9 (6-12) years. Procedural success was achieved in 251 patients (91.6%). Procedural complications occurred in 4 patients (1.4%), consisting of stent migration in 1 (0.3%) and small non-expanding non-flow-limiting aortic wall injuries in 3 (1.1%). Major vascular access complications were observed in 18 patients (6.6%), acute limb ischemia in 8 (2.9%). In-hospital mortality occurred in 4 patients (1.4%). Five-year cumulative incidence rates of stent fractures, reCoA, and aortic aneurysmal/pseudoaneurysmal formation were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Of 73 reCoAs, 47 were treated with balloon angioplasty, and 15 underwent a second stent implantation. Five-year all-cause mortality occurred in 4/251 (1.6%) patients. Coarctoplasty with stents was safe and effective in our pediatric population during a 5-year follow-up despite a high rate of reCoA.
PubMed: 38940826
DOI: 10.1007/s00246-024-03551-4 -
Alternative Therapies in Health and... Jun 2024To investigate the effects of holistic nursing on the quality of life overall, inflammation, and lung function in older persons experiencing acute episodes of chronic...
OBJECTIVE
To investigate the effects of holistic nursing on the quality of life overall, inflammation, and lung function in older persons experiencing acute episodes of chronic obstructive pulmonary disease (COPD).
METHODS
Considering that good nursing care improves cardiorespiratory fitness, increases treatment adherence and improves prognosis in patients with chronic obstructive pulmonary disease (COPD), From June 2019 through May 2020, 96 patients with newly diagnosed acute COPD will be recruited to take part in the trial. In total, 48 people were split into the study group and the control group at random. When compared to the control group, the research group received more comprehensive care. Procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) blood levels were compared before and after care, as were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FEV1, and quality of life.
RESULTS
None of the demographic characteristics, including mean age, BMI, illness duration, gender, or comorbidities, differed significantly (P > .05) between the two groups. After care, serum PCT, CRP, and IL-6 levels decreased in both groups compared to pre-nursing values (P < .05); however, after care, serum PCT, CRP, and IL-6 levels were significantly lower in the study group compared to the control group. Both groups' FEV1, FVC, and FVC improved significantly (P < .05) after care compared to their baseline conditions; Statistics show that after care, the study group had significantly better FEV1, FVC, and FVC than the control group. The overall success rate of the study group was statistically significantly higher than that of the control group (P < .05). After Care, both groups' scores for illness impact, disease symptoms, and mobility restriction were much lower than they were before to care, and the difference was statistically significant (P < .05); After Care, people in the study group significantly improved on measures of mobility impairment, sickness symptoms, and disease effect compared to those in the control group. There was a statistically significant difference (P < .05) between the two groups. Patients in the study group reported significantly higher levels of satisfaction with their nursing care than patients in the control group (P < .05).
CONCLUSION
Elderly patients with acute COPD can benefit greatly from holistic nursing care in terms of reduced inflammation, enhanced lung function, and enhanced quality of life.
PubMed: 38940789
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Cadmium poisoning is mainly caused by inhalation of cadmium dust or cadmium compound dust, which greatly harms people's lives. Tea polyphenols extracted from green tea...
Effect of Tea Polyphenols on Nuclear Factor Erythroid 2-related Factor 2 (NRF2) and Kelch-like ECH-associated Protein 1 (KEAP1) Gene Expression in Mice with Acute Cadmium Poisoning.
BACKGROUND
Cadmium poisoning is mainly caused by inhalation of cadmium dust or cadmium compound dust, which greatly harms people's lives. Tea polyphenols extracted from green tea have wide biological properties, including anti-cardiovascular disease, anti-tumor, anti-inflammatory, and immune regulation. The transcription factor nuclear factor erythroid 2-related factor 2 (NRF2) and Kelch-like ECH-associated protein 1 (KEAP1) are involved in the regulation of cadmium-induced oxidative damage. However, whether tea polyphenols relieve acute cadmium poisoning via regulating NRF2 and KEAP1 gene expression remains unclear.
OBJECTIVE
To explore the influences of tea polyphenols on NRF2 and KEAP1 gene expression in mice with acute cadmium poisoning.
DESIGN
This is an animal experiment that adopts hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) staining.
SETTING
This study was carried out in Zunyi Medical and Pharmaceutical College.
PARTICIPANTS
Fifty specific pathogen-free (SPF) male Kunming mice aged 9 weeks, weighing 18-22 g were divided into five groups: normal group, model group, low-dose tea polyphenols group, middle-dose tea polyphenols group, and high-dose tea polyphenols group.
INTERVENTIONS
Tea polyphenols were administered intraastrically into mice with doses of 50 mg/kg, 100 mg/kg, and 200 mg/kg for 10 consecutive days, respectively.
OBSERVATION INDICATORS
(1) liver coefficient, (2) pathological liver injury, (3) liver function, (4) oxidative damage, and (5) NRF2 and KEAP1 gene expression.
RESULTS
The liver coefficient, pathological liver injury, serum aspartate transaminase and alanine transaminase levels of the model group were higher relative to the normal group (P < .05). Relative to the model group, different doses of tea polyphenols treatment significantly relieved liver coefficient, pathological liver injury, serum aspartate transaminase, and alanine transaminase levels (P < .05). Malondialdehyde content in liver tissues of the model group was significantly higher compared to the normal group, while glutathione together with glutathione peroxidase contents of the model group was lower (P < .05). Compared to the model group, malondialdehyde content in liver tissues declined while glutathione together with glutathione peroxidase contents were elevated after different doses of tea polyphenols treatment (P < .05). Relative to the normal group, NRF2 expression in the liver tissues of the model group was significantly lower, while KEAP1 expression was higher (P < .05). Relative to the model group, NRF2 expression in the liver tissues was elevated after treatment of different doses of tea polyphenols, while KEAP1 expression was declined (P < .05).
CONCLUSION
Tea polyphenols can relieve liver injury in mice with acute cadmium poisoning by regulating NRF2 and KEAP1 expression. Our study might provide a promising treatment strategy for acute cadmium poisoning.
PubMed: 38940783
DOI: No ID Found -
Journal of Pediatric Hematology/oncology Jun 2024Programmed death-1 (PD1) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have a vital role in immune checkpoint pathways. Single nucleotide polymorphisms (SNPs)...
Relationship Between Cytotoxic T-Lymphocyte-Associated Antigen-4: Programmed Death-1 Genes Polymorphisms and Susceptibility to Pediatric B-Cell Acute Lymphoblastic Leukemia.
Programmed death-1 (PD1) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have a vital role in immune checkpoint pathways. Single nucleotide polymorphisms (SNPs) of PD1 and CTLA4 have been reported to be associated with susceptibility to certain autoimmune diseases and cancers. The potential association between SNPs in these immune checkpoint genes and risk of acute lymphoblastic leukemia (ALL) still unclear. The aim of this study is to clarify the effect of PD1 and CTLA4 SNPs on the risk of developing ALL and the prognosis of the disease. The study was performed on 100 pediatric B-ALL patients and 100 controls. The PD1 and CTLA4 SNPs were examined by RFLP technique. The study revealed that CTLA4 (rs11571316) was associated with high risk of B-ALL developments OR 1.492 (CI: 1157 to 1924) (P=0.002). PD1 (rs36084323) GA genotype was significantly associated with protective effect against nonremission (P=0.007). PD1 (rs36084323) A allele were associated with protective effect against relapse (P=0.008). CTLA4 and PD1 genotypes did not have significant impact on B-ALL patients outcome. The current study displayed for the first time that genetic variations of the CTLA-4, was associated with susceptibility to B-ALL and that PD1 (rs36084323) GA genotype was significantly associated with protective effect against nonremission, while PD1 (rs36084323) A allele was associated with protective effect against relapse.
PubMed: 38940594
DOI: 10.1097/MPH.0000000000002909