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Journal of Cardiovascular Development... May 2024The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence,... (Review)
Review
The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients' quality of life.
PubMed: 38921666
DOI: 10.3390/jcdd11060166 -
Infection and Drug Resistance 2024Minocycline, a derivative of tetracycline, has anti- () properties and can be used to treat infection. However, only a few randomized controlled trials (RCTs) have... (Clinical Trial)
Clinical Trial
BACKGROUND
Minocycline, a derivative of tetracycline, has anti- () properties and can be used to treat infection. However, only a few randomized controlled trials (RCTs) have investigated the efficacy of minocycline-containing quadruple therapy (MCQT) in treating infection. This study aimed to determine the efficacy and safety of MCQT and investigate the factors influencing both aspects.
METHODS
This was a retrospective cohort study. Patients diagnosed with infection between January 1, 2022, and July 31, 2023 at. The primary outcome was the eradication rate of , and the secondary outcome was the number and type of adverse events.
RESULTS
A total of 828 patients were included in this study. The overall eradication rate among the included patients at 95% confidence interval (CI) (Range 0.864 to 0.907) was 88.53%. The eradication rate for patients who received MCQT regimen as the primary therapy was 92.28% (95% CI: 0.901-0.945), significantly higher than that of patients who received MCQT as rescue therapy (80.81%; 95% CI: 0.761-0.855, 0.003). Adverse events, including dizziness, abdominal distension, diarrhea, nausea, abdominal discomfort, constipation, headache, rash, sleep disorder, palpitation, backache, and anorexia, occurred in 185 (22.34%) patients, with dizziness being the most common (75/828, 9.06%). Compliance with MCQT therapy was an independent factor influencing eradication in patients receiving MCQT as a primary therapy. Compliance and presence or absence of infection symptoms at the time of screening were independent factors influencing eradication in patients receiving MCQT as rescue therapy. Factors that influenced the occurrence of adverse events included reasons for infection screening, residence, treatment compliance, and the use of acid-suppressant regimens.
CONCLUSION
MCQT regimens were effective in infection eradication, and the treatment resulted only in fewer adverse events when used as primary or rescue therapies for infection treatment. Future prospective studies with larger sample sizes and more comprehensive data are needed to validate our findings.
PubMed: 38919832
DOI: 10.2147/IDR.S457618 -
Journal of the Saudi Heart Association 2024Identifying the infarct-related artery (IRA) in a non-ST-segment-elevation acute myocardial infarction (NSTEMI) can be very challenging, particularly in a hospital that...
Identifying the infarct-related artery (IRA) in a non-ST-segment-elevation acute myocardial infarction (NSTEMI) can be very challenging, particularly in a hospital that cannot perform intracoronary imaging due to certain limitations. This is because, by angiography, most patients present with multivessel coronary artery disease (CAD), diffuse disease, or non-significant CAD. We present a case of a 60-year-old female patient presented with substernal chest pain and palpitations of 6 h duration. The first hospital contact 12-lead electrocardiogram (ECG) showed ventricular tachycardia (VT) with unstable hemodynamics, after stabilization patient was transported to the catheterization laboratory for immediate percutaneous coronary intervention (PCI). With a clue of VT morphology, post-converted ECG, and coronary angiography, the patient successfully underwent PCI in the left circumflex artery.
PubMed: 38919508
DOI: 10.37616/2212-5043.1377 -
Journal of Cardiovascular Medicine... Jun 2024The role of epicardial adipose tissue (EAT) in cardiovascular health has undergone a paradigm shift in recent years, evolving from a passive reservoir into a dynamic...
INTRODUCTION
The role of epicardial adipose tissue (EAT) in cardiovascular health has undergone a paradigm shift in recent years, evolving from a passive reservoir into a dynamic contributor to cardiovascular risk. This case critically examines the multifaceted functions of EAT, explores its implications for cardiovascular risk, and discusses the potential benefits of the GLP-1 receptor agonist Liraglutide in mitigating its effects.
CASE PRESENTATION
We present the case of a 62-year-old male patient who is obese, hypertensive, and has a history of chronic coronary syndrome. He was admitted to the emergency room with complaints of palpitations and shortness of breath. The 12-lead ECG revealed atrial fibrillation with a rapid ventricular response and evidence of a new-onset left bundle branch block. The transthoracic echocardiogram showed heart-rate-dependent regional dyskinesias, while both echocardiographic and computed tomographic scan findings indicated the presence of thick EAT. A coronary angiogram showed intrastent restenosis in the left anterior descending artery, which was treated with percutaneous revascularization. To address residual cardiovascular risk, the patient was initiated on Liraglutide during hospitalization. The follow-up revealed reduced low-density lipoprotein-cholesterol and high-sensitivity C-reactive protein levels, along with a decrease in EAT thickness and BMI, accompanied by improved echocardiographic parameters.
DISCUSSION
Targeted interventions aimed at reducing EAT are imperative given its active role in cardiovascular risk. GLP-1 receptor agonists, such as Liraglutide, hold promise in mitigating the effects of EAT and represent a potential avenue for therapeutic exploration in addressing residual cardiovascular risk.
PubMed: 38916237
DOI: 10.2459/JCM.0000000000001652 -
Pulmonary Circulation Apr 2024Pulmonary hypertension (PH) adds a substantial disease burden, including higher mortality, when associated with interstitial lung disease (ILD), a severe, chronic,...
Pulmonary hypertension (PH) adds a substantial disease burden, including higher mortality, when associated with interstitial lung disease (ILD), a severe, chronic, progressive condition. Yet little is known of the lived experiences, perspectives, priorities, and viewpoints of patients and carers living with PH-ILD. The Voice of the Patient meeting at the center of this qualitative research study aims to provide these difficult-to-obtain insights from a European perspective for the first time. The multistakeholder approach brought together four PH-ILD patients, three primary caregivers, two patient associations, clinical experts, sponsor representatives, and a facilitator. Of the six major themes identified in the thematic analysis, symptoms, and physical limitations were the most impactful. Shortness of breath was the most bothersome symptom affecting patients daily. Further symptoms included fatigue, cough, dizziness, syncope, edema, and palpitations. Physical limitations focused on reduced mobility, impacting patients' ability to perform daily tasks, hobbies, sports, and to enjoy travel. Existing antifibrotic and pulmonary arterial hypertension-targeted treatments were perceived as beneficial. However, despite advances in treatment, severe disease burdens and high unmet medical needs persist from the perspectives of patients. Most meaningful to patients' daily wellbeing was supplemental oxygen, enabling greater mobility. Patients and carers reported difficulties and barriers in navigating the healthcare system and obtaining adequate information to reduce their considerable uncertainties, documenting the substantial challenges that rare and complex conditions such as PH-ILD pose for routine clinical practice beyond PH expert centers and indicating an urgent need for high-quality patient- and clinician-directed information to support patient-centered care.
PubMed: 38911184
DOI: 10.1002/pul2.12405 -
BMJ Case Reports Jun 2024A woman in her 60s presented to the emergency department with excruciating, deep left shoulder pain and was found to have a right-sided Morgagni hernia, a rare type of...
A woman in her 60s presented to the emergency department with excruciating, deep left shoulder pain and was found to have a right-sided Morgagni hernia, a rare type of congenital diaphragmatic hernia (CDH). She did not have chest pain, palpitations, shortness of breath, cough, abdominal pain, constipation, diarrhoea, nausea, vomiting or other symptoms classically associated with CDHs in adults. Laparoscopic robotic-assisted repair with mesh placement was performed, and the patient's recovery was uncomplicated, with no recurrence of shoulder pain. Our patient's presentation was unusual due to the absence of symptoms typically seen with CDHs in adults, and the presence of contralateral, left-sided shoulder pain with a right-sided Morgagni hernia.
Topics: Humans; Female; Hernias, Diaphragmatic, Congenital; Shoulder Pain; Middle Aged; Laparoscopy; Herniorrhaphy; Robotic Surgical Procedures; Tomography, X-Ray Computed; Surgical Mesh; Diagnosis, Differential
PubMed: 38908835
DOI: 10.1136/bcr-2023-257631 -
Frontiers in Pharmacology 2024With a variety of active ingredients, () can treat a variety of tumors. The purpose of our study is based on real-world data and experimental level, to double...
BACKGROUND
With a variety of active ingredients, () can treat a variety of tumors. The purpose of our study is based on real-world data and experimental level, to double demonstrate the efficacy and possible molecular mechanism of in the treatment of lung adenocarcinom (LUAD).
METHODS
Phenotype-genotype and herbal-target associations were extracted from the SymMap database. Disease-gene associations were extracted from the MalaCards database. A molecular network-based correlation analysis was further conducted on the collection of genes associated with TCM and the collection of genes associated with diseases and symptoms. Then, the network separation S metrics were applied to evaluate the network proximity relationship between TCM and symptoms. Finally, cell apoptosis experiment, Western blot, and Real-time PCR were used for biological experimental level validation analysis.
RESULTS
Included in the study were 85,437 electronic medical records (318 patients with LUAD). The proportion of prescriptions containing in the LUAD group was much higher than that in the non-LUAD group ( < 0.005). We counted the symptom relief of patients in the group and the group without the use of : except for symptoms such as fatigue, palpitations, and dizziness, the improvement rate of symptoms in the user group was higher than that in the non-use group. We selected the five most frequently occurring symptoms in the use group, namely, cough, expectoration, fatigue, chest tightness and wheezing. We combined the above five symptom genes into one group. The overlapping genes obtained were CTNNB1, STAT3, CASP8, and APC. The selection of CTNNB1 target for biological experiments showed that the proliferation rate of LUAD A549 cells in the drug intervention group was significantly lower than that in the control group, and it was concentration-dependent. can promote the apoptosis of A549 cells, and the apoptosis rate of the high-concentration drug group is significantly higher than that of the low-concentration drug group. The transcription and expression level of CTNNB1 gene in the drug intervention group were significantly decreased.
CONCLUSION
inhibits the proliferation and promotes apoptosis of LUAD A549 cells, which may be related to the fact that can regulate the expression of CTNNB1.
PubMed: 38903989
DOI: 10.3389/fphar.2024.1355531 -
Journal of Psychoactive Drugs Jun 2024Data on medication interactions with psychedelics are limited. Here we present what may be the first published report of a hypertensive emergency following the...
Data on medication interactions with psychedelics are limited. Here we present what may be the first published report of a hypertensive emergency following the combination of psilocybin mushrooms with a monoamine oxidase inhibitor (MAOI). A 42-year-old man with treatment-resistant major depressive disorder took 1 g of mushrooms, while prescribed tranylcypromine, extended-release dextroamphetamine-amphetamine, and other medications. Approximately half an hour later, he developed severe hypertension with chest pain, palpitations, and headache. Upon hospital presentation, the electrocardiogram demonstrated ST-elevation. The patient was diagnosed with a myocardial infarction and treated with lorazepam, nitroglycerin, and aspirin. He subsequently underwent emergency cardiac catheterization, which revealed no significant cardiac abnormalities. Following overnight hospitalization, he was discharged home with no lasting physical sequelae. Though data are few, past studies suggest that classic serotonergic psychedelics (5HT-2A receptor agonists) such as dimethyltryptamine (DMT), lysergic acid (LSD), and synthetic psilocybin should not produce hypertensive emergency when combined with MAOIs. We suspect phenylethylamine, found in and other species of psilocybin mushrooms, interacted with tranylcypromine and dextroamphetamine-amphetamine to produce this hypertensive emergency. Patients prescribed MAOIs should be warned of the potential for hypertensive emergency when consuming psilocybin mushrooms, particularly when also prescribed norepinephrine releasers such as dextroamphetamine-amphetamine.
PubMed: 38903003
DOI: 10.1080/02791072.2024.2368617 -
Journal of Nippon Medical School =... Jun 2024Painless thyroiditis, which is rare in children, exhibits the characteristic sequence of hyperthyroidism, including aggressive and disruptive behaviors. Unlike subacute...
Painless thyroiditis, which is rare in children, exhibits the characteristic sequence of hyperthyroidism, including aggressive and disruptive behaviors. Unlike subacute thyroiditis or Graves' disease, painless thyroiditis is challenging to diagnose because of its mild symptoms and minimal or absent physical findings. Moreover, aggressive and disruptive behaviors in children with psychiatric disorders may be misconstrued as exacerbation of underlying symptoms. The present patient was a 16-year-old male with adjustment disorder who presented to a pediatric psychiatric clinic for assessment of irritability. After 4 months, he developed aggressive and disruptive behaviors that prompted initiation of risperidone but without improvement. After 1 month, he reported palpitations and dyspnea. His neck was supple and non-tender without thyroid enlargement. Thyroid studies revealed elevated free T4 and T3 levels and suppressed thyroid-stimulating hormone level, suggesting hyperthyroidism. A radioactive iodine uptake test revealed a barely visible thyroid gland, consistent with thyroiditis. Painless thyroiditis, without thyroid tenderness, was diagnosed. We describe a case of painless thyroiditis in an adolescent patient with aggressive and disruptive behaviors that were initially attributed to worsening of an underlying adjustment disorder. Even when minimal or no signs of hyperthyroidism are present, painless thyroiditis should be considered in the differential diagnosis of children with aggressive and disruptive behaviors. Awareness of potential anchoring bias is also recommended to prevent its delayed diagnosis of such behaviors.
PubMed: 38897946
DOI: 10.1272/jnms.JNMS.2025_92-302 -
Heart Rhythm Jun 2024
PubMed: 38897334
DOI: 10.1016/j.hrthm.2024.06.024