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BMC Nephrology May 2024Acute kidney injury (AKI) is associated with increased risk of heart failure (HF). Determining the type of HF experienced by AKI survivors (heart failure with preserved...
INTRODUCTION
Acute kidney injury (AKI) is associated with increased risk of heart failure (HF). Determining the type of HF experienced by AKI survivors (heart failure with preserved or reduced ejection fraction, HFpEF or HFrEF) could suggest potential mechanisms underlying the association and opportunities for improving post-AKI care.
METHODS
In this retrospective study of adults within the Vanderbilt University health system with a diagnosis of HF, we tested whether AKI events in the two years preceding incident HF associated more with HFpEF or HFrEF while controlling for known predictors. HF outcomes were defined by administrative codes and classified as HFpEF or HFrEF by echocardiogram data. We used multivariable logistic regression models to estimate the effects of AKI on the odds of incident HFpEF versus HFrEF.
RESULTS
AKI (all stages) trended towards a preferential association with HFpEF in adjusted analyses (adjusted OR 0.80, 95% CI 0.63 - 1.01). Stage 1 AKI was associated with higher odds of HFpEF that was statistically significant (adjusted OR 0.62, 95% CI 0.43 - 0.88), whereas stages 2-3 AKI showed a trend toward HFrEF that did not reach statistical significance (adjusted OR 1.11, 95% CI 0.76 - 1.63).
CONCLUSIONS
AKI as a binary outcome trended towards a preferential association with HFpEF. Stage 1 AKI was associated with higher odds of HFpEF, whereas stage 2-3 trended towards an association with HFrEF that did not meet statistical significance. Different mechanisms may predominate in incident HF following mild versus more severe AKI. Close follow-up with particular attention to volume status and cardiac function after discharge is warranted after even mild AKI.
Topics: Humans; Acute Kidney Injury; Heart Failure; Male; Female; Retrospective Studies; Aged; Middle Aged; Stroke Volume
PubMed: 38760794
DOI: 10.1186/s12882-024-03602-1 -
BMJ Open May 2024To investigate current care for people with Long COVID in England.
OBJECTIVE
To investigate current care for people with Long COVID in England.
DESIGN
In-depth, semistructured interviews with people living with Long COVID and Long COVID healthcare professionals; data analysed using thematic analysis.
SETTING
National Health Service England post-COVID-19 services in six clinics from November 2022 to July 2023.
PARTICIPANTS
15 healthcare professionals and 21 people living with Long COVID currently attending or discharged (18 female; 3 male).
RESULTS
Health professionals and people with lived experience highlighted the multifaceted nature of Long COVID, including its varied symptoms, its impact on people's lives and the complexity involved in managing this condition. These impacts encompass physical, social, mental and environmental dimensions. People with Long COVID reported barriers in accessing primary care, as well as negative general practitioner consultations where they felt unheard or invalidated, though some positive interactions were also noted. Peer support or support systems proved highly valuable and beneficial for individuals, aiding their recovery and well-being. Post-COVID-19 services were viewed as spaces where overlooked voices found validation, offering more than medical expertise. Despite initial challenges, healthcare providers' increasing expertise in diagnosing and treating Long COVID has helped refine care approaches for this condition.
CONCLUSION
Long COVID care in England is not uniform across all locations. Effective communication, specialised expertise and comprehensive support systems are crucial. A patient-centred approach considering the unique complexities of Long COVID, including physical, mental health, social and environmental aspects is needed. Sustained access to post-COVID-19 services is imperative, with success dependent on offering continuous rehabilitation beyond rapid recovery, acknowledging the condition's enduring impacts and complexities.
Topics: Humans; COVID-19; England; Male; Female; Qualitative Research; Middle Aged; Aged; SARS-CoV-2; Adult; Interviews as Topic; Health Services Accessibility; Primary Health Care; Post-Acute COVID-19 Syndrome; Health Personnel; State Medicine
PubMed: 38760030
DOI: 10.1136/bmjopen-2023-080967 -
BMJ Open May 2024Common mental health conditions (CMHCs), including depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries...
Effectiveness of combining prevention psychological interventions with interventions that address the social determinants of mental health in low and middle-income countries: protocol of a systematic review and meta-analysis.
INTRODUCTION
Common mental health conditions (CMHCs), including depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries (LMICs). Preventive strategies combining psychological interventions with interventions addressing the social determinants of mental health may represent a key strategy for effectively preventing CMHCs. However, no systematic reviews have evaluated the effectiveness of these combined intervention strategies for preventing CMHCs.
METHODS AND ANALYSIS
This systematic review will include randomised controlled trials (RCTs) focused on the effectiveness of interventions that combine preventive psychological interventions with interventions that address the social determinants of mental health in LMICs. Primary outcome is the frequency of depression, anxiety or PTSD at postintervention as determined by a formal diagnostic tool or any other standardised criteria. We will search Epistemonikos, Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Global Index Medicus, ClinicalTrials.gov (Ctgov), International Clinical Trials Registry Platform (ICTRP). Two reviewers will independently extract the data and evaluate the risk of bias of included studies using the Cochrane risk of bias tool 2. Random-effects meta-analyses will be performed, and certainty of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation approach.
ETHICS AND DISSEMINATION
This study uses data from published studies; therefore, ethical review is not required. Findings will be presented in a published manuscript.
TRIAL REGISTRATION NUMBER
CRD42023451072.
Topics: Humans; Systematic Reviews as Topic; Developing Countries; Social Determinants of Health; Research Design; Psychosocial Intervention; Stress Disorders, Post-Traumatic; Meta-Analysis as Topic; Mental Health; Depression; Mental Disorders; Anxiety; Randomized Controlled Trials as Topic
PubMed: 38760028
DOI: 10.1136/bmjopen-2023-083261 -
Seminars in Thrombosis and Hemostasis May 2024
PubMed: 38759956
DOI: 10.1055/s-0044-1786751 -
Revista Portuguesa de Cardiologia :... May 2024
PubMed: 38759915
DOI: 10.1016/j.repc.2024.05.004 -
Cell Reports Methods May 2024Organoids, self-organizing three-dimensional (3D) structures derived from stem cells, offer unique advantages for studying organ development, modeling diseases, and... (Review)
Review
Organoids, self-organizing three-dimensional (3D) structures derived from stem cells, offer unique advantages for studying organ development, modeling diseases, and screening potential therapeutics. However, their translational potential and ability to mimic complex in vivo functions are often hindered by the lack of an integrated vascular network. To address this critical limitation, bioengineering strategies are rapidly advancing to enable efficient vascularization of organoids. These methods encompass co-culturing organoids with various vascular cell types, co-culturing lineage-specific organoids with vascular organoids, co-differentiating stem cells into organ-specific and vascular lineages, using organoid-on-a-chip technology to integrate perfusable vasculature within organoids, and using 3D bioprinting to also create perfusable organoids. This review explores the field of organoid vascularization, examining the biological principles that inform bioengineering approaches. Additionally, this review envisions how the converging disciplines of stem cell biology, biomaterials, and advanced fabrication technologies will propel the creation of increasingly sophisticated organoid models, ultimately accelerating biomedical discoveries and innovations.
PubMed: 38759654
DOI: 10.1016/j.crmeth.2024.100779 -
PLoS Genetics May 2024Ribosomal DNA (rDNA), which encodes ribosomal RNA, is an essential but unstable genomic element due to its tandemly repeated nature. rDNA's repetitive nature causes...
Ribosomal DNA (rDNA), which encodes ribosomal RNA, is an essential but unstable genomic element due to its tandemly repeated nature. rDNA's repetitive nature causes spontaneous intrachromatid recombination, leading to copy number (CN) reduction, which must be counteracted by a mechanism that recovers CN to sustain cells' viability. Akin to telomere maintenance, rDNA maintenance is particularly important in cell types that proliferate for an extended time period, most notably in the germline that passes the genome through generations. In Drosophila, the process of rDNA CN recovery, known as 'rDNA magnification', has been studied extensively. rDNA magnification is mediated by unequal sister chromatid exchange (USCE), which generates a sister chromatid that gains the rDNA CN by stealing copies from its sister. However, much remains elusive regarding how germ cells sense rDNA CN to decide when to initiate magnification, and how germ cells balance between the need to generate DNA double-strand breaks (DSBs) to trigger USCE vs. avoiding harmful DSBs. Recently, we identified an rDNA-binding Zinc-finger protein Indra as a factor required for rDNA magnification, however, the underlying mechanism of action remains unknown. Here we show that Indra is a negative regulator of rDNA magnification, balancing the need of rDNA magnification and repression of dangerous DSBs. Mechanistically, we show that Indra is a repressor of RNA polymerase II (Pol II)-dependent transcription of rDNA: Under low rDNA CN conditions, Indra protein amount is downregulated, leading to Pol II-mediated transcription of rDNA. This results in the expression of rDNA-specific retrotransposon, R2, which we have shown to facilitate rDNA magnification via generation of DBSs at rDNA. We propose that differential use of Pol I and Pol II plays a critical role in regulating rDNA CN expansion only when it is necessary.
PubMed: 38758955
DOI: 10.1371/journal.pgen.1011136 -
PloS One 2024The use of the Sequential Organ Failure Assessment (SOFA) score, originally developed to describe disease morbidity, is commonly used to predict in-hospital mortality....
The use of the Sequential Organ Failure Assessment (SOFA) score, originally developed to describe disease morbidity, is commonly used to predict in-hospital mortality. During the COVID-19 pandemic, many protocols for crisis standards of care used the SOFA score to select patients to be deprioritized due to a low likelihood of survival. A prior study found that age outperformed the SOFA score for mortality prediction in patients with COVID-19, but was limited to a small cohort of intensive care unit (ICU) patients and did not address whether their findings were unique to patients with COVID-19. Moreover, it is not known how well these measures perform across races. In this retrospective study, we compare the performance of age and SOFA score in predicting in-hospital mortality across two cohorts: a cohort of 2,648 consecutive adult patients diagnosed with COVID-19 who were admitted to a large academic health system in the northeastern United States over a 4-month period in 2020 and a cohort of 75,601 patients admitted to one of 335 ICUs in the eICU database between 2014 and 2015. We used age and the maximum SOFA score as predictor variables in separate univariate logistic regression models for in-hospital mortality and calculated area under the receiver operator characteristic curves (AU-ROCs) and area under precision-recall curves (AU-PRCs) for each predictor in both cohorts. Among the COVID-19 cohort, age (AU-ROC 0.795, 95% CI 0.762, 0.828) had a significantly better discrimination than SOFA score (AU-ROC 0.679, 95% CI 0.638, 0.721) for mortality prediction. Conversely, age (AU-ROC 0.628 95% CI 0.608, 0.628) underperformed compared to SOFA score (AU-ROC 0.735, 95% CI 0.726, 0.745) in non-COVID-19 ICU patients in the eICU database. There was no difference between Black and White COVID-19 patients in performance of either age or SOFA Score. Our findings bring into question the utility of SOFA score-based resource allocation in COVID-19 crisis standards of care.
Topics: Humans; COVID-19; Male; Hospital Mortality; Middle Aged; Female; Organ Dysfunction Scores; Aged; Retrospective Studies; Age Factors; Intensive Care Units; Adult; SARS-CoV-2; ROC Curve; Aged, 80 and over
PubMed: 38758942
DOI: 10.1371/journal.pone.0301013 -
PloS One 2024Dementia, a major global health concern, is an acquired disorder that causes a progressive decline in cognitive abilities, affecting learning and memory, language,...
INTRODUCTION
Dementia, a major global health concern, is an acquired disorder that causes a progressive decline in cognitive abilities, affecting learning and memory, language, executive function, complex attention, perceptual-motor skills, and social cognition. Our study aims to evaluate the knowledge and attitudes regarding dementia and Alzheimer's disease among medical students.
METHODS
This cross-sectional study was conducted among 393 medical students in Palestine from August 2023 to November 2023. The assessment of knowledge and attitude toward dementia was measured using the Alzheimer's Disease Knowledge Scale (ADKS) and Dementia Attitude Scale (DAS). The data were analyzed using SPSS version 26, and the Mann-Whitney U-test and the Kruskal-Wallis test were used to compare the mean between the groups with a 5% significance level.
RESULTS
The overall mean score of the student's knowledge of dementia measured by the ADKS was 18.91 (±3.32 SD) out of 30. The mean score of the student's attitude toward dementia measured by the DAS was 91.68 (±3.32 SD). Clinical students had higher ADKS scores than pre-clinical students (p-value < 0.001). No significant differences in the knowledge and attitudes toward dementia were found between males and females. The medical students' knowledge and attitude scores were positively correlated (ρ = 0.227, p-value <0.001).
CONCLUSION
Palestinian medical student's knowledge about Alzheimer's disease and dementia is insufficient, with students in the clinical phase showing better understanding than pre-clinical students. The findings highlight a necessity for enhancing the dementia curriculum and conducting further studies to evaluate training's impact on students' knowledge and attitudes.
Topics: Humans; Students, Medical; Male; Female; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Dementia; Alzheimer Disease; Young Adult; Arabs; Adult; Middle East; Surveys and Questionnaires
PubMed: 38758934
DOI: 10.1371/journal.pone.0304012 -
PloS One 2024We have previously shown that polygenic risk scores (PRS) can improve risk stratification of peripheral artery disease (PAD) in a large, retrospective cohort. Here, we...
We have previously shown that polygenic risk scores (PRS) can improve risk stratification of peripheral artery disease (PAD) in a large, retrospective cohort. Here, we evaluate the potential of PRS in improving the detection of PAD and prediction of major adverse cardiovascular and cerebrovascular events (MACCE) and adverse events (AE) in an institutional patient cohort. We created a cohort of 278 patients (52 cases and 226 controls) and fit a PAD-specific PRS based on the weighted sum of risk alleles. We built traditional clinical risk models and machine learning (ML) models using clinical and genetic variables to detect PAD, MACCE, and AE. The models' performances were measured using the area under the curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), and Brier score. We also evaluated the clinical utility of our PAD model using decision curve analysis (DCA). We found a modest, but not statistically significant improvement in the PAD detection model's performance with the inclusion of PRS from 0.902 (95% CI: 0.846-0.957) (clinical variables only) to 0.909 (95% CI: 0.856-0.961) (clinical variables with PRS). The PRS inclusion significantly improved risk re-classification of PAD with an NRI of 0.07 (95% CI: 0.002-0.137), p = 0.04. For our ML model predicting MACCE, the addition of PRS did not significantly improve the AUC, however, NRI analysis demonstrated significant improvement in risk re-classification (p = 2e-05). Decision curve analysis showed higher net benefit of our combined PRS-clinical model across all thresholds of PAD detection. Including PRS to a clinical PAD-risk model was associated with improvement in risk stratification and clinical utility, although we did not see a significant change in AUC. This result underscores the potential clinical utility of incorporating PRS data into clinical risk models for prevalent PAD and the need for use of evaluation metrics that can discern the clinical impact of using new biomarkers in smaller populations.
Topics: Humans; Peripheral Arterial Disease; Female; Male; Aged; Middle Aged; Risk Assessment; Risk Factors; Machine Learning; Cardiovascular Diseases; Retrospective Studies; Multifactorial Inheritance; Case-Control Studies; Area Under Curve; Genetic Risk Score
PubMed: 38758931
DOI: 10.1371/journal.pone.0303610