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Batu ED, Bayindir Y, Sener S, Balik Z, Aliyev E, Cuceoglu MK, Basaran O, Bilginer Y, Ozen S. A treatment algorithm for familial Mediterranean fever patients with menstruation-associated attacks. Rheumatology (Oxford) 2024:keae256. [PMID: 38710490 DOI: 10.1093/rheumatology/keae256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) is characterized by febrile polyserositis attacks. Menstruation could be a trigger for attacks. We aimed to analyze the features of adolescent FMF patients with menstruation-associated attacks and propose a management algorithm. METHODS All female FMF patients who had menarche and visited the Pediatric Rheumatology Unit between January-December 2022, were included into this study. Demographics, general characteristics, and the features of menstrual cycle and FMF attacks were noted. RESULTS A total of 151 female FMF patients were included. Thirty-five (23.2%) had menstruation-associated attacks. Fever and arthritis were less frequent during the menstruation-associated attacks than the attacks not associated with menstruation in these patients (65.7% vs 88.6%, p= 0.01 and 2.9% vs 20%, p= 0.04; respectively). Patients with menstruation-associated FMF attacks were younger at symptom onset and diagnosis (2.5 vs 5 years, p= 0.004 and 4 vs 7 years, p= 0.01; respectively), had a higher rate of dysmenorrhea (74.3% vs 38.8%, p< 0.001, respectively) and higher pre- and post-menarche attack frequency (4 vs 2 and 10 vs 0, respectively; p< 0.001 for both) than patients whose attacks were not associated with menstruation. The interventions for menstruation-associated attacks included initiating colchicine, increasing the dose of colchicine, switching from coated to compressed colchicine tablets or anti-interleukin 1 drugs, and on-demand non-steroidal anti-inflammatory drugs, on-demand glucocorticoids, and on-demand anakinra. On-demand therapies were beneficial in controlling menstruation-associated attacks. CONCLUSIONS This is the largest cohort of adolescent FMF patients with menstruation-associated attacks. Severe FMF may cause tendency to this association. On-demand therapies could be preferred in the management.
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Affiliation(s)
- Ezgi Deniz Batu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Yagmur Bayindir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Seher Sener
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Zeynep Balik
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Emil Aliyev
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Ozge Basaran
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Yelda Bilginer
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
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Mohideen A, Ber LT, Hussain H, Gohsman ZM. A Delayed Diagnosis of Bilateral Pediatric Trigger Thumbs: A Case Report and Literature Review. J Pediatr Health Care 2024; 38:e1-e4. [PMID: 38697700 DOI: 10.1016/j.pedhc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 05/05/2024]
Abstract
We describe the case of a 6-year-old female who presented with tender nodules and fixed flexion of her thumbs, diagnosed as bilateral pediatric trigger thumb. Though present since infancy, her condition was not diagnosed in prior clinical visits. Pediatric trigger digit is a clinical diagnosis, often missed if the digit's range of motion is not assessed routinely. Given the duration, pain, and severity of her condition, conservative management was deferred, and she was referred for surgery. An approach to clinical management is discussed. Ultimately, further study is required to develop structured management guidelines for pediatric trigger digit.
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Licht C, Al-Dakkak I, Anokhina K, Isbel N, Frémeaux-Bacchi V, Gilbert RD, Greenbaum LA, Ariceta G, Ardissino G, Schaefer F, Rondeau E. Characterization of patients with aHUS and associated triggers or clinical conditions: A Global aHUS Registry analysis. Nephrology (Carlton) 2024. [PMID: 38604995 DOI: 10.1111/nep.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/07/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Atypical haemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) associated with complement dysregulation; aHUS may be associated with other 'triggers' or 'clinical conditions'. This study aimed to characterize this patient population using data from the Global aHUS Registry, the largest collection of real-world data on patients with aHUS. METHODS Patients enrolled in the Global aHUS Registry between April 2012 and June 2021 and with recorded aHUS-associated triggers or clinical conditions prior/up to aHUS onset were analysed. aHUS was diagnosed by the treating physician. Data were classified by age at onset of aHUS (< or ≥18 years) and additionally by the presence/absence of identified pathogenic complement genetic variant(s) and/or anti-complement factor H (CFH) antibodies. Genetically/immunologically untested patients were excluded. RESULTS 1947 patients were enrolled in the Global aHUS Registry by June 2021, and 349 (17.9%) met inclusion criteria. 307/349 patients (88.0%) had a single associated trigger or clinical condition and were included in the primary analysis. Malignancy was most common (58/307, 18.9%), followed by pregnancy and acute infections (both 53/307, 17.3%). Patients with an associated trigger or clinical condition were generally more likely to be adults at aHUS onset. CONCLUSION Our analysis suggests that aHUS-associated triggers or clinical conditions may be organized into clinically relevant categories, and their presence does not exclude the concurrent presence of pathogenic complement genetic variants and/or anti-CFH antibodies. Considering a diagnosis of aHUS with associated triggers or clinical conditions in patients presenting with TMA may allow faster and more appropriate treatment.
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Affiliation(s)
- Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Imad Al-Dakkak
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | | | - Nicole Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Rodney D Gilbert
- Regional Paediatric Nephro-Urology Unit, Southampton Children's Hospital, Southampton, UK
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Gema Ariceta
- Department of Pediatric Nephrology, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Gianluigi Ardissino
- Centro per la Cura e lo Studio della Sindrome Emolitico-Uremica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
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Tenge T, Schallenburger M, Batzler YN, Roth S, M Pembele R, Stroda A, Böhm L, Bernhard M, Jung C, Meier S, Kindgen-Milles D, Kienbaum P, Schwartz J, Neukirchen M. Perceptions on Specialist Palliative Care Involvement During and After Cardiopulmonary Resuscitation: A Qualitative Study. Crit Care Explor 2024; 6:e1077. [PMID: 38605722 PMCID: PMC11008654 DOI: 10.1097/cce.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
IMPORTANCE Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care. OBJECTIVES This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed. DESIGN SETTING AND PARTICIPANTS A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical). ANALYSIS The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz. RESULTS Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors). CONCLUSIONS Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.
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Affiliation(s)
- Theresa Tenge
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Yann-Nicolas Batzler
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René M Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Lennert Böhm
- Emergency Department, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Bernhard
- Emergency Department, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stefan Meier
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Peter Kienbaum
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Martin Neukirchen
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Stevens ER, Li R, Xiang G, Wisniewski R, Rojas S, O'Connor K, Wilker O, Vojjala M, El-Shahawy O, Sherman SE. Trial Participants' Perceptions of the Impact of Ecological Momentary Assessment on Smoking Behaviors: Qualitative Analysis. JMIR Mhealth Uhealth 2024; 12:e52122. [PMID: 38270520 PMCID: PMC10837109 DOI: 10.2196/52122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 01/26/2024] Open
Abstract
Background Ecological momentary assessment (EMA) is an increasingly used tool for data collection in behavioral research, including smoking cessation studies. As previous addiction research suggests, EMA has the potential to elicit cue reactivity by triggering craving and increasing behavioral awareness. However, there has been limited evaluation of its potential influence on behavior. Objective By examining the perspectives of research participants enrolled in a tobacco treatment intervention trial, this qualitative analysis aims to understand the potential impact that EMA use may have had on smoking behaviors that may not have otherwise been captured through other study measures. Methods We performed a qualitative analysis of in-depth interviews with participants enrolled in a pilot randomized controlled trial of a tobacco treatment intervention that used SMS text messaging to collect EMA data on smoking behaviors. In the pilot randomized controlled trial, combustible cigarette and e-cigarette use and smoking-related cravings were measured as part of an EMA protocol, in which SMS text messaging served as a smoking diary. SMS text messaging was intended for data collection only and not designed to serve as part of the intervention. After a baseline assessment, participants were asked to record daily nicotine use for 12 weeks by responding to text message prompts that they received 4 times per day. Participants were prompted to share their experiences with the EMA text messaging component of the trial but were not directly asked about the influence of EMA on their behaviors. Transcripts were coded according to the principles of the framework for applied research. The codes were then examined, summarized, and grouped into themes based on the principles of grounded theory. Results Interviews were analyzed for 26 participants. The themes developed from the analysis suggested the potential for EMA, in the form of an SMS text messaging smoking diary, to influence participants' smoking behaviors. The perceived impacts of EMA text messaging on smoking behaviors were polarized; some participants emphasized the positive impacts of text messages on their efforts to reduce smoking, while others stressed the ways that text messaging negatively impacted their smoking reduction efforts. These contrasting experiences were captured by themes reflecting the positive impacts on smoking behaviors, including increased awareness of smoking behaviors and a sense of accountability, and the negative impacts on emotions and smoking behaviors, including provoking a sense of guilt and triggering smoking behaviors. Conclusions The collection of EMA smoking behavior data via SMS text messaging may influence the behaviors and perceptions of participants in tobacco treatment interventions. More research is needed to determine the magnitude of impact and mechanisms, to account for the potential effects of EMA. A broader discussion of the unintended effects introduced by EMA use is warranted among the research community.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Rina Li
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Grace Xiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Rachel Wisniewski
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sidney Rojas
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Katherine O'Connor
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Olivia Wilker
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Mahathi Vojjala
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- School of Global Public Health, New York University, New York, NY, United States
| | - Omar El-Shahawy
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- School of Global Public Health, New York University, New York, NY, United States
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Morse BL, Karian V. Supporting the Young Adulthood Transitions in Women With Migraine. Nurs Womens Health 2023; 27:457-466. [PMID: 37804861 DOI: 10.1016/j.nwh.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/09/2023]
Abstract
Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual's 18th birthday. Women's health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women's health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.
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Ramirez JM, Calderon-Zavala AC, Balaram A, Heldwein EE. In vitro reconstitution of herpes simplex virus 1 fusion identifies low pH as a fusion co- trigger. mBio 2023; 14:e0208723. [PMID: 37874146 PMCID: PMC10746285 DOI: 10.1128/mbio.02087-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023] Open
Abstract
Membrane fusion mediated by herpes simplex virus 1 (HSV-1) is a complex, multi-protein process that is receptor triggered and can occur both at the cell surface and in endosomes. To deconvolute this complexity, we reconstituted HSV-1 fusion with synthetic lipid vesicles in vitro. Using this simplified, controllable system, we discovered that HSV-1 fusion required not only a cognate host receptor but also low pH. On the target membrane side, efficient fusion required cholesterol, negatively charged lipids found in the endosomal membranes, and an optimal balance of lipid order and disorder. On the virion side, the four HSV-1 entry glycoproteins-gB, gD, gH, and gL-were sufficient for fusion. We propose that low pH is a biologically relevant co-trigger for HSV-1 fusion. The dependence of fusion on low pH and endosomal lipids could explain why HSV-1 enters most cell types by endocytosis. We hypothesize that under neutral pH conditions, other, yet undefined, cellular factors may serve as fusion co-triggers. The in vitro fusion system established here can be employed to systematically investigate HSV-1-mediated membrane fusion.IMPORTANCEHSV-1 causes lifelong, incurable infections and diseases ranging from mucocutaneous lesions to fatal encephalitis. Fusion of viral and host membranes is a critical step in HSV-1 infection of target cells that requires multiple factors on both the viral and host sides. Due to this complexity, many fundamental questions remain unanswered, such as the identity of the viral and host factors that are necessary and sufficient for HSV-1-mediated membrane fusion and the nature of the fusion trigger. Here, we developed a simplified in vitro fusion assay to examine the fusion requirements and identified low pH as a co-trigger for virus-mediated fusion in vitro. We hypothesize that low pH has a critical role in cell entry and, potentially, pathogenesis.
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Affiliation(s)
- J. Martin Ramirez
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Graduate Program in Molecular Microbiology, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
- Medical Scientist Training Program, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ariana C. Calderon-Zavala
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Graduate Program in Molecular Microbiology, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ariane Balaram
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Graduate Program in Molecular Microbiology, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ekaterina E. Heldwein
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Graduate Program in Molecular Microbiology, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
- Medical Scientist Training Program, Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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Honda D, Ohsawa I, Aizawa M, Miyamoto I, Uzawa K, Asanuma K. Multidisciplinary Prophylactic Strategies for Recurrence of Laryngeal Edema After Tooth Extraction in a Patient With Hereditary Angioedema: A Case Report. Cureus 2023; 15:e46869. [PMID: 37841987 PMCID: PMC10567609 DOI: 10.7759/cureus.46869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/17/2023] Open
Abstract
Hereditary angioedema (HAE), caused by C1-inhibitor (C1-INH) deficiency or dysfunction, is a rare and potentially life-threatening disease that leads to unpredictable recurrent attacks of angioedema in localized regions, including the larynx. As medical or dental procedures can trigger laryngeal edema, resulting in asphyxiation, major global guidelines recommend short-term prophylaxis prior to invasive procedures and long-term prophylaxis to prevent acute attacks and achieve near-normal lives. Here, we report the case of a 63-year-old male who experienced asphyxiation after tooth extraction. Emergency tracheotomy had saved his life at the age of 40 years, before the diagnosis of HAE. At the age of 63, when he had another opportunity for tooth extraction, he was definitively diagnosed with HAE. Administering short-term prophylaxis with ongoing long-term prophylaxis for HAE and perioperative multidisciplinary management for tooth extraction helped prevent recurrent fatal angioedema due to dental procedures and this can be useful when managing patients with HAE.
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Affiliation(s)
- Daisuke Honda
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Isao Ohsawa
- Department of Internal Medicine, Nephrology Unit, Saiyū Sōka Hospital, Sōka, JPN
| | - Masashi Aizawa
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Isao Miyamoto
- Department of Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, JPN
| | - Katsuhiro Uzawa
- Department of Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, JPN
| | - Katsuhiko Asanuma
- Department of Nephrology, Graduate School of Medicine, Chiba University, Chiba, JPN
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Nakamura K, Sasaki T, Minami K, Aoki H, Kondo K, Miki Y, Goto K, Take Y, Kaseno K, Naito S. Noncontact Charge Density Mapping-Guided Ablation of Persistent Atrial Fibrillation With a Multiple Trigger-Based Mechanism. JACC Case Rep 2023; 21:101957. [PMID: 37719288 PMCID: PMC10500338 DOI: 10.1016/j.jaccas.2023.101957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/19/2023]
Abstract
We present a case of radiofrequency catheter ablation of persistent atrial fibrillation (AF) with a trigger-based mechanism, guided by novel noncontact charge density mapping, which resulted in the simultaneous achievement of the termination of AF and complete elimination of multiple triggers that induced repeated recurrences of AF immediately after cardioversion. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kentaro Minami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Hideyuki Aoki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kan Kondo
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Gunma, Japan
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10
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Liu J, Luo C, Guo Y, Cao F, Yan J. Individual trigger factors for hemorrhagic stroke: Evidence from case-crossover and self-controlled case series studies. Eur Stroke J 2023; 8:808-818. [PMID: 37641550 PMCID: PMC10472950 DOI: 10.1177/23969873231173285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Hemorrhagic stroke (HS) is a sudden-onset disease with high mortality and disability rates, and it is crucial to explore the triggers of HS. In this study, we analyzed individual triggers for HS to provide a basis for HS prevention and intervention. METHODS A systematic search of five databases was conducted until December 2022. Studies on HS-related individual triggers conducted using a case-crossover study or self-controlled case series design were included in the descriptive summary and comprehensive evidence synthesis of each trigger. RESULTS A total of 39 studies were included after the screening, and 32 trigger factor categories were explored for associations. Potential trigger factors for HS were as follows: Antiplatelet (odd ratio (OR), 1.10; 95% confidence interval (CI), 1.00-1.21) and anticoagulant (OR, 5.43; 95% CI, 2.04-14.46) medications, mood stabilizers/antipsychotics (OR, 1.33; 95% CI, 1.07-1.65), infections (OR, 2.15; 95% CI, 1.73-2.67), vaccinations (relative risk, 1.11; 95% CI, 1.02-1.21), physical exertion (OR, 2.08; 95% CI, 1.58-2.74), cola consumption (OR, 5.45; 95% CI, 2.76-10.76), sexual activity (OR, 7.49; 95% CI, 2.23-25.22), nose blowing (OR range, 2.40-56.40), defecation (OR, 16.94; 95% CI, 3.40-84.37), and anger (OR, 3.59; 95% CI, 1.56-8.26). No associations were observed with illicit drug use (OR, 2.05; 95% CI, 0.52-8.06) or cigarette smoking (OR, 0.81; 95% CI, 0.52-1.24) and HS. CONCLUSIONS Individual triggers, including several medications, infections, vaccinations, and behaviors, may trigger HS onset. Direct control measures for behavioral triggers can play a crucial role in preventing HS. High-risk populations should receive personalized therapies and monitoring measures during the medication treatment to balance the risk of acute HS and the basic diseases.
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Affiliation(s)
- Junyu Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chun Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yuxin Guo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fang Cao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
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11
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Liu J, Luo C, Hu C, Guo Y, Cao F, Li Y, Yuan D, Jiang W, Yan J. Behavioral trigger factors for hemorrhagic stroke: a case-crossover study. Postgrad Med J 2023; 99:1013-1019. [PMID: 37209147 DOI: 10.1093/postmj/qgad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/30/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The role and extent of the effects of short-term behavioral factors on the risk of hemorrhagic stroke (HS) are unclear. This study aimed to assess and quantify behavioral trigger factors (BTFs) for HS and identify the differences in BTFs between Chinese and other populations. METHODS A case-crossover study was performed from March 2021 to February 2022. New-onset HS patients were recruited from two university hospitals in China. The patients were interviewed to evaluate their exposure to 20 potential BTFs during the predefined risk and control periods and to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). A comprehensive literature review was conducted to synthesize the evidence. RESULTS A total of 284 patients with HS were included (150 with intracerebral hemorrhage and 134 with subarachnoid hemorrhage). Multivariate regression analysis showed that straining for defecation (OR: 3.06; 95% CI: 1.01-8.40), weightlifting (OR: 4.82; 95% CI: 1.02-22.83), overeating (OR: 4.33; 95% CI: 1.24-15.21), heavy physical exertion (OR: 3.02; 95% CI: 1.18-7.78), and chess/cards/mahjong games (OR: 2.51; 95% CI: 1.05-6.01) were associated with an increased risk within 2 hours before HS onset, and critical life events (OR: 3.81; 95% CI: 1.06-13.74) were associated with an increased risk 7 days before the onset of HS. Exposure to anger (OR: 3.17; 95% CI: 1.73-5.81) and heavy physical exertion (OR: 2.12; 95% CI: 1.65, 2.74) showed an increased risk of HS events after the pooled analysis. CONCLUSIONS Several behavioral activities and mood modifications are associated with the onset of HS. In addition to the common BTFs, Chinese patients have specific BTFs due to their habits and customs distinct from those of different populations in other regions. Key messages What is already known on this topic It is known that several behavioral trigger factors (BTFs) are associated with the onset of hemorrhagic stroke (HS), such as vigorous physical exercise and anger. Evidence for other potential trigger factors was of less robustness. Which BTFs contribute to HS among the Chinese population is poorly understood, since individuals in different countries and regions have their own habits of life and customs. What this study adds Our study identified that two special behaviors, chess/card/mahjong games and critical life events, were associated with the onset of HS in Chinese populations, besides heavy physical exertion, weightlifting, overeating, and straining for defecation, which were previously reported in other populations. Heavy physical exertion and anger could potentially increase the risk of HS based on a comprehensive aggregation and evidence synthesis. How this study might affect research, practice, or policy Patients in different populations or regions may possess specific BTFs owing to their distinct habits and customs. Avoidance of these behaviors and regulation of emotions to maintain a steady mentality would help minimize exposure and prevent the disease for high-risk populations in China.
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Affiliation(s)
- Junyu Liu
- Department of Neurosurgery, XiangYa Hospital, Central South University, Changsha, 410008, China
- Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto, 606-8501, Japan
| | - Chun Luo
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, 410078, China
| | - Chongyu Hu
- Department of Neurology, Hunan Province People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Yuxin Guo
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, 410078, China
| | - Fang Cao
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, 410078, China
| | - Yifeng Li
- Department of Neurosurgery, XiangYa Hospital, Central South University, Changsha, 410008, China
| | - Dun Yuan
- Department of Neurosurgery, XiangYa Hospital, Central South University, Changsha, 410008, China
| | - Weixi Jiang
- Department of Neurosurgery, XiangYa Hospital, Central South University, Changsha, 410008, China
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, 410078, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, XiangYa School of Public Health, Central South University, Changsha, 410078, China
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12
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Singh N, Kashyap A, Patel G, Vatsa R. Using GnRH agonists in combination with hCG in antagonist ART cycles: A SCOPING Review of recent evidences. JBRA Assist Reprod 2023; 27. [PMID: 37579268 DOI: 10.5935/1518-0557.20230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Assisted Reproductive technology encompasses all techniques involving ovarian stimulation to produce high-quality oocytes and manipulation of both oocytes and sperm in vitro to produce embryos for the purpose of reproduction. The final maturation of oocytes induced by a "trigger" is a crucial step with the potential to affect in vitro fertilization outcomes. Human chorionic gonadotropin has traditionally been used as a substitute for luteinizing hormone to induce final oocyte maturation and meiosis. However, this practice may cause a potentially fatal iatrogenic complication known as ovarian hyperstimulation syndrome, which can cause significant morbidity and, in rare cases, death in otherwise healthy women. Thus, gonadotropin releasing hormone agonists have been promoted as a safer alternative for inducing oocyte maturation, albeit at the expense of luteal phase defect. Since then, various combinations of gonadotropin releasing hormone agonists and human chorionic gonadotropin have been tried. This scoping review evaluates these trigger combinations in various types of responders.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aryan Kashyap
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Vatsa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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13
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Boukhvalova MS, Kastrukoff L, Blanco JCG. Alzheimer's disease and multiple sclerosis: a possible connection through the viral demyelinating neurodegenerative trigger (vDENT). Front Aging Neurosci 2023; 15:1204852. [PMID: 37396655 PMCID: PMC10310923 DOI: 10.3389/fnagi.2023.1204852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Alzheimer's disease (AD) and multiple sclerosis (MS) are two CNS disorders affecting millions of people, for which no cure is available. AD is usually diagnosed in individuals age 65 and older and manifests with accumulation of beta amyloid in the brain. MS, a demyelinating disorder, is most commonly diagnosed in its relapsing-remitting (RRMS) form in young adults (age 20-40). The lack of success in a number of recent clinical trials of immune- or amyloid-targeting therapeutics emphasizes our incomplete understanding of their etiology and pathogenesis. Evidence is accumulating that infectious agents such as viruses may contribute either directly or indirectly. With the emerging recognition that demyelination plays a role in risk and progression of AD, we propose that MS and AD are connected by sharing a common environmental factor (a viral infection such as HSV-1) and pathology (demyelination). In the viral DEmyelinating Neurodegenerative Trigger (vDENT) model of AD and MS, the initial demyelinating viral (e.g., HSV-1) infection provokes the first episode of demyelination that occurs early in life, with subsequent virus reactivations/demyelination and associated immune/inflammatory attacks resulting in RRMS. The accumulating damage and/or virus progression deeper into CNS leads to amyloid dysfunction, which, combined with the inherent age-related defects in remyelination, propensity for autoimmunity, and increased blood-brain barrier permeability, leads to the development of AD dementia later in life. Preventing or diminishing vDENT event(s) early in life, thus, may have a dual benefit of slowing down the progression of MS and reducing incidence of AD at an older age.
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Affiliation(s)
| | - Lorne Kastrukoff
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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14
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Rogala M, Gajewski J. Crashworthiness Analysis of Thin-Walled Square Columns with a Hole Trigger. Materials (Basel) 2023; 16:ma16114196. [PMID: 37297330 DOI: 10.3390/ma16114196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Thin-walled structures dynamically loaded with an axial force are the subject of this study. The structures work as passive energy absorbers by progressive harmonic crushing. The absorbers were made of AA-6063-T6 aluminum alloy and subjected to both numerical and experimental tests. Experimental tests were performed on an INSTRON 9350 HES bench, while numerical analyses were performed using Abaqus software. The energy absorbers tested had crush initiators in the form of drilled holes. The variable parameters were the number of holes and their diameter. The holes were located in a line 30 mm away from the base. This study shows a significant effect of the hole diameter on the values of the stroke efficiency indicator and mean crushing force.
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Affiliation(s)
- Michał Rogala
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, 20-618 Lublin, Poland
| | - Jakub Gajewski
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, 20-618 Lublin, Poland
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15
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Gottlieb LA, Dekker LRC, Coronel R. Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation. Front Physiol 2023; 14:1157338. [PMID: 37293260 PMCID: PMC10244566 DOI: 10.3389/fphys.2023.1157338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
Atrial fibrillation (AF) often requires invasive treatment by ablation to decrease symptom burden. The pulmonary veins (PV) are thought to trigger paroxysms of AF, and ablative PV isolation (PVI) is a cornerstone in AF treatment. However, incomplete PVI, where electrical conduction between the PV and left atrium (LA) is maintained, is curative of AF in a subset of patients. This implies that an antiarrhythmic effect other than electrical isolation between the PV and LA plays a role in AF prevention in these patients. We reason that the PV myocardium constitutes an arrhythmogenic substrate conducive to reentry in the patients with curative incomplete PVI. This PV substrate is amenable to ablation, even when conduction between the LA and PV persists. We propose that PV ablation strategies are differentiated to fit the arrhythmogenic mechanisms in the individual patient. PV substrate modification in patients with PV reentry may constitute a new therapeutic approach that is potentially simpler and more effective, in this subgroup of patients.
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Affiliation(s)
- Lisa A. Gottlieb
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Amsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas R. C. Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ruben Coronel
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Amsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, Netherlands
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16
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Abstract
The relationship between viral infection and onset of autoimmune diseases such as systemic lupus erythematosus remains uncertain. During the COVID-19 pandemic, organ-specific and multisystemic autoimmune phenomena temporally related to the viral infection have been described. Immune dysregulation triggered by the SARS-CoV-2 virus leading to hyperactivation of both the innate and adaptive immune systems contributes to the excessive production of pro-inflammatory cytokines, autoantibodies, and subsequent autoimmune manifestations. We report two patients without known autoimmune diseases who developed lupus nephritis shortly after a documented mild SARS-CoV-2 infection. Together with other similar cases in the literature, the observation supports a viral trigger of the development of systemic lupus erythematosus in susceptible individuals.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Chiu Sum Chu
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Sau Mei Tse
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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17
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Donno V, García-Martínez S, Polyzos NP. Female BMI and Body Weight Is Not Associated with Oocyte Yield and Maturation in hCG, Agonist or Dual Trigger Cycles: A Large Observational Study including 5000 Cycles. J Clin Med 2023; 12:jcm12093249. [PMID: 37176689 PMCID: PMC10179424 DOI: 10.3390/jcm12093249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Triggering final oocyte maturation is a key step of ovarian stimulation. Although previous studies demonstrated a negative association between female BMI and serum hCG levels, little evidence is available regarding the association between oocyte yield and patients' BMI. The scope of the current study was to examine whether the efficiency of the r-hCG and triptorelin to trigger final oocyte maturation may be associated with patients' BMI or weight. METHODS This is a retrospective observational study including 5190 ovarian stimulation cycles performed between January 2019 and September 2022 in the Reproductive Medicine Department of Dexeus University Hospital. Cycles were analyzed according to the type of trigger (triptorelin vs. r-hCG vs. dual). The primary outcome measures were oocyte maturation rate (MII/oocytes) and FOI (oocytes/AFC); secondary outcomes were oocyte and MII yield. RESULTS Multivariable regression analysis, adjusting for confounding factors, demonstrated that BMI was not associated with oocyte maturation rate (OR: 1.00 [95%CI: 0.99; 1.01]), FOI (Beta 0.52 [95%CI: -0.49; 1.54]), number of oocytes (Beta 0.02 [95%CI: -0.08; 0.13]) or MIIs (Beta 0.01 [95%CI: -0.08; 0.10]) retrieved. Similarly, all analyses conducted considering patients' weight failed to reveal any association. CONCLUSION Our study demonstrates that, independent of the type of trigger, patients' BMI and weight are not associated with oocyte yield, maturation, or FOI.
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Affiliation(s)
- Valeria Donno
- Department of Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain
| | | | - Nikolaos P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Ghent, 9000 Gent, Belgium
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18
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Luján M, Lalmolda C. Ventilators, Settings, Autotitration Algorithms. J Clin Med 2023; 12:jcm12082942. [PMID: 37109277 PMCID: PMC10141077 DOI: 10.3390/jcm12082942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
The choice of a ventilator model for a single patient is usually based on parameters such as size (portability), presence or absence of battery and ventilatory modes. However, there are many details within each ventilator model about triggering, pressurisation or autotitration algorithms that may go unnoticed, but may be important or may justify some drawbacks that may occur during their use in individual patients. This review is intended to emphasize these differences. Guidance is also provided on the operation of autotitration algorithms, in which the ventilator is able to take decisions based on a measured or estimated parameter. It is important to know how they work and their potential sources of error. Current evidence on their use is also provided.
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Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
- Centro de Investigacion Biomédica en Red (CIBERES), 28029 Madrid, Spain
| | - Cristina Lalmolda
- Servei de Pneumologia, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain
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19
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Čulić V, AlTurki A, Vio R, Proietti R, Jerončić A. Acute myocardial infarction triggered by physical exertion: a systematic review and meta-analysis. Eur J Prev Cardiol 2023:7040369. [PMID: 36790838 DOI: 10.1093/eurjpc/zwad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
AIMS While regular physical activity has clear benefits to cardiovascular health, physical exertion can trigger acute myocardial infarction (AMI). We aimed to estimate how many AMIs may be attributed to bouts of physical exertion, and to explore possible modifiers of this association. METHODS MEDLINE, ISI Web of Science, and Scopus databases were searched for case-crossover studies reporting the relative risk (RR) of exertion-related AMI and exposure prevalence in the control periods. We used random-effects model to pool the RR estimates, and mixed-effects model and random-effects meta-regression for subgroup analyses, and estimated the population attributable fraction (PAF) at population level and in different subgroups. The study met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses requirements. RESULTS Twelve studies including 19 891 AMI patients met the criteria for inclusion. There was a strong overall association between episodic physical exertion and AMI (RR=3.46; 95% confidence interval [CI], 3.16-3.78). The total PAF was 10.6% (95% CI, 9.44-11.83). For each additional year of age, the RR of exertion-related AMI increased by approximately 3%, but the PAF decreased by 2%. For each additional time of habitual activity per week the RR of exertion-related AMI decreased by approximately 43%. The impact was greater among those engaged in physical exertion one to three times a week (≥20% of cases), and among those who did not take compared to those who took ß-blocker (p=0.049). CONCLUSIONS Every tenth AMI may be assigned to physical exertion. The impact was more pronounced among younger patients, those exposed to exertion one to three times a week, and those not-taking ß-blockers.
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Affiliation(s)
- Viktor Čulić
- Department of Cardiology and Angiology, University Hospital Centre Split, Split, Croatia.,University of Split School of Medicine, Split, Croatia
| | - Ahmed AlTurki
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Riccardo Vio
- Cardiology Unit, Department of Cardiothoracic and Vascular Medicine, Ospedale dell'Angelo, Venice, Italy
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Ana Jerončić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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20
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Czempik PF, Wilczek D, Herzyk J, Krzych ŁJ. Appropriateness of Allogeneic Red Blood Cell Transfusions in Non-Bleeding Patients in a Large Teaching Hospital: A Retrospective Study. J Clin Med 2023; 12:jcm12041293. [PMID: 36835829 PMCID: PMC9963308 DOI: 10.3390/jcm12041293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
In hemodynamically stable patients, both anemia and red blood cell (RBC) transfusion may be detrimental to patients; hence, a decision regarding RBC transfusion should be based on thorough risk-benefit assessment. According to hematology and transfusion medicine organizations, RBC transfusion is indicated when recommended hemoglobin (Hb) triggers are met, and symptoms of anemia are present. The aim of our study was to examine the appropriateness of RBC transfusions in non-bleeding patients at our institution. We performed a retrospective analysis of all RBC transfusions performed between January 2022 and July 2022. The appropriateness of RBC transfusion was based on the most recent Association for the Advancement of Blood and Biotherapies (AABB) guidelines and some additional criteria. The overall incidence of RBC transfusions at our institution was 10.2 per 1000 patient-days. There were 216 (26.1%) RBC units appropriately transfused and 612 (73.9%) RBC units that were transfused with no clear indications. The incidence of appropriate and inappropriate RBC transfusions were 2.6 and 7.5 per 1000 patient-days, respectively. The most frequent clinical situations when RBC transfusion was classified as appropriate were: Hb < 70 g/L plus cognitive problems/headache/dizziness (10.1%), Hb < 60 g/L (5.4%), and Hb < 70 g/L plus dyspnea despite oxygen therapy (4.3%). The most frequent causes of inappropriate RBC transfusions were: no Hb determination pre-RBC transfusion (n = 317) and, among these, RBC transfused as a second unit in a single-transfusion episode (n = 260); absence of anemia sings/symptoms pre-transfusion (n = 179); and Hb concentration ≥80 g/L (n = 80). Although the incidence of RBC transfusions in non-bleeding inpatients in our study was generally low, the majority of RBC transfusions were performed outside recommended indications. Red blood cell transfusions were evaluated as inappropriate mainly due to multiple-unit transfusion episodes, absence of anemia signs and/or symptoms pre- transfusion, and liberal transfusion triggers. There is still the need to educate physicians on appropriate indications for RBC transfusion in non-bleeding patients.
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Affiliation(s)
- Piotr F. Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Transfusion Committee, University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence: ; Tel.: +48-32-789-42-01
| | - Dawid Wilczek
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jan Herzyk
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Sane M, Marjamaa A, Kuusisto J, Raatikainen P, Karvonen J. Novel findings of an old algorithm: PVC response "Atrial Pace'' initiates atrial arrhythmias in Abbott ICD and CRT-D devices. Pacing Clin Electrophysiol 2023; 46:125-131. [PMID: 36402455 DOI: 10.1111/pace.14622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many algorithms have been developed to ensure the safety and accuracy of cardiac implantable electric devices (CIED). A specific algorithm designed to prevent pacemaker induced tachycardia (PMT) after a premature ventricular complex (PVC response) is available in all Abbott (former St. Jude Medical) CIED. However, a few case reports suggest that this algorithm may be proarrhythmic when programmed to Atrial Pace (A-Pace on PVC). METHODS We analyzed the data of all (n = 333) Abbot implantable cardioverter defibrillator (ICD) and cardiac resynchronization defibrillator (CRT-D) devices followed remote using the Merlin.net Patient Care Network in our institute in 2020. Status of the PVC response algorithm A-Pace on PVC or Off was collected, and all atrial mode switch (AMS) episodes longer than 30 s were thoroughly evaluated. Data on clinical characteristics of the patients was collect from the electronic patient records. RESULTS A total of 173 patients had A-Pace on PVC and twenty-five of them (14%) had at least one atrial high rate episode (AHRE) >30 s (AHRE) triggered by the action of this algorithm. The median PVC count was higher in patients who had algorithm triggered AHRE than in those with no algorithm-triggered AHRE (1.7% [IQR 0-3.2] vs. 0% [IQR 0-1.1], p < .0001). The major clinical characteristics were comparable in the two groups. CONCLUSION The A-Pace on PVC setting was frequently used in our patients. Our study shows that a considerable number of patients had at least one AHRE triggered by the algorithm. The use of this algorithm should be carefully reconsidered.
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Affiliation(s)
- Markus Sane
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Helsinki University, Helsinki, Finland
| | - Annukka Marjamaa
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Helsinki University, Helsinki, Finland
| | - Jouni Kuusisto
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Helsinki University, Helsinki, Finland
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Helsinki University, Helsinki, Finland
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Adebiyi OT, Galloway DF, Augustin MS, Sinha AA. The multifactorial complexities of autoimmune development in Pemphigus vulgaris: Critical evaluation of the role of environmental and lifestyle "exposome" factors. Front Immunol 2023; 13:1058759. [PMID: 36703956 PMCID: PMC9871583 DOI: 10.3389/fimmu.2022.1058759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Pemphigus vulgaris (PV) is a potentially life-threatening blistering disorder characterized by autoantibodies directed against cell-cell adhesion molecules that serves as an excellent model to study human autoimmune development. Numerous studies have identified specific Human Leukocyte Antigen (HLA) genes, in particular DRB1*0402 and DQB1*0503, that confer disease risk. Although HLA is required, it is not sufficient for the initiation of disease. As with all autoimmune diseases, the etio-pathogenesis of PV is complex, meaning it is multifactorial. Susceptibility is polygenic, and the search for non-HLA disease-linked genes continues. Moreover, twin studies across autoimmune conditions indicate that non-genetic environmental and lifestyle factors, which can be collectively grouped under the term "exposome", are also major contributors to disease development. The literature presents evidence for the potential role of multiple triggers such as medications, infections, stress, diet, immunizations, and sleep to influence the etiology, pathophysiology, and prognosis of PV. However, a clear understanding of the degree to which specific factors impact PV is lacking. In this investigation, we comprehensively review the environmental elements listed above and consider the strength of evidence for these factors. The overall goals of this work are to provide greater insights into the factors that influence disease susceptibility, disease development and disease course and ultimately help to better guide clinicians and inform patients in the management of PV.
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Yang J, Gao J, Wang Y, Liu H, Lian X. Impact of follicular size categories on oocyte quality at trigger day in young and advanced-age patients undergoing GnRH-ant therapy. Front Endocrinol (Lausanne) 2023; 14:1167395. [PMID: 37124736 PMCID: PMC10140496 DOI: 10.3389/fendo.2023.1167395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Aim To study the effect of follicle sizes of different proportions on oocyte and embryo quality in young and advanced-age patients, and provide evidence for personalized protocol adjustment. Methods This was a retrospective real-world data study including a total of 11,462 patients who had started their first in vitro fertilization cycle with a gonadotropin-releasing hormone antagonist (GnRH-ant) protocol during 2018-2021. We classified patients into groups according to the size of the dominant proportion of follicles on the human chorionic gonadotropin (hCG) trigger day: Large, Medium, Small, and Equal (containing equivalent proportions of all three size categories). The Cochran-Mantel-Haenszel test by different Anti-Mullerian Hormone (AMH) and antral follicle count (AFC) was used to compare factors such as the metaphase II (MII) oocyte rate, normal fertilization rate, and two pronuclei (2PN) cleavage rate between groups. General linear model (GLM) analysis was performed for inter-group comparison of the oocyte and embryo quality. Results In patients aged < 35 years and with AMH ≥ 1.2μg/L, the MII oocyte percentages in the Large and Medium groups were significantly higher than in the Small group (P < 0.001). The germinal vesicle (GV) oocyte and unavailable oocyte percentages in the Large and Medium groups were lower than in the Small group (P < 0.001). Among patients aged ≥ 35 years with AFC < 5 and AMH ≥ 1.2μg/L, the GV oocyte percentage in the Large group was significantly lower than in the Medium group (2.54% vs. 4.46%, P < 0.001). In patients < 35 years, the GLM demonstrated that the Large and Medium groups had positively impacted on the development of MII oocyte and live birth rate(LBR) of first embryo transfer(ET)(β>0, all P value < 0.05);and had less likely to develop into unavailable oocyte, degenerated oocyte, GV oocyte and MI oocyte rates relative to the Small group(β<0, all P value < 0.05). And among patients ≥ 35 years, the Medium group had positively impacted on the development of MII oocyte and 2PN rates relative to the Small group(β>0, all P value < 0.05); and had less likely to develop into MI oocytes relative to the Small group(β<0, all P value < 0.05). The GLM indicated that AMH, along with Gn total dose, start dose, and Gn days, had significant impact on oocyte and embryo quality. For young patients, age was not a significant influencing factor, but for advanced-age patients, age influenced the outcomes. Conclusion Our analysis suggests that for young patients (< 35 years), triggering when there is a high proportion of large or medium follicles results in better quality oocytes, while for older patients (≥ 35 years), it is better to trigger when the proportion of medium follicles is no less than that of small follicles. Further research is required to confirm these findings.
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Affiliation(s)
- Jingwei Yang
- Chongqing Key Laboratory of Human Embryo Engineering, Center for Reproductive Medicine, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jing Gao
- Department of Academic Affairs, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuting Wang
- Department of Medical Records and Statistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongya Liu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xuemei Lian
- School of Public Health, Chongqing Medical University, Chongqing, China
- *Correspondence: Xuemei Lian,
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Cluitmans MJM, Bayer J, Bear LR, ter Bekke RMA, Heijman J, Coronel R, Volders PGA. The circle of reentry: Characteristics of trigger-substrate interaction leading to sudden cardiac arrest. Front Cardiovasc Med 2023; 10:1121517. [PMID: 37139119 PMCID: PMC10150924 DOI: 10.3389/fcvm.2023.1121517] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Sudden cardiac death is often caused by ventricular arrhythmias driven by reentry. Comprehensive characterization of the potential triggers and substrate in survivors of sudden cardiac arrest has provided insights into the trigger-substrate interaction leading to reentry. Previously, a "Triangle of Arrhythmogenesis", reflecting interactions between substrate, trigger and modulating factors, has been proposed to reason about arrhythmia initiation. Here, we expand upon this concept by separating the trigger and substrate characteristics in their spatial and temporal components. This yields four key elements that are required for the initiation of reentry: local dispersion of excitability (e.g., the presence of steep repolarization time gradients), a critical relative size of the region of excitability and the region of inexcitability (e.g., a sufficiently large region with early repolarization), a trigger that originates at a time when some tissue is excitable and other tissue is inexcitable (e.g., an early premature complex), and which occurs from an excitable region (e.g., from a region with early repolarization). We discuss how these findings yield a new mechanistic framework for reasoning about reentry initiation, the "Circle of Reentry." In a patient case of unexplained ventricular fibrillation, we then illustrate how a comprehensive clinical investigation of these trigger-substrate characteristics may help to understand the associated arrhythmia mechanism. We will also discuss how this reentry initiation concept may help to identify patients at risk, and how similar reasoning may apply to other reentrant arrhythmias.
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Affiliation(s)
- Matthijs J. M. Cluitmans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Philips Research, Eindhoven, Netherlands
- Correspondence: Matthijs J. M. Cluitmans
| | | | | | - Rachel M. A. ter Bekke
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Paul G. A. Volders
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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Douillet D, Chouihed T, Bertoletti L, Roy PM. Pulmonary Embolism and Respiratory Deterioration in Chronic Cardiopulmonary Disease: A Narrative Review. Diagnostics (Basel) 2023; 13. [PMID: 36611433 DOI: 10.3390/diagnostics13010141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or even a secondary diagnosis. The prevalence of pulmonary embolism in these patients is unknown, especially in cases of chronic heart failure. The challenge lies in needing to carry out a systematic or targeted diagnostic strategy for pulmonary embolism. The occurrence of a pulmonary embolism in patients with chronic cardiopulmonary disease clearly worsens their prognosis. In this narrative review, we study pulmonary embolism and chronic obstructive pulmonary disease, after which we turn to pulmonary embolism and chronic heart failure.
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Moady G, Ali O, Sweid R, Atar S. The Role of Stress in Stable Patients with Takotsubo Syndrome-Does the Trigger Matter? J Clin Med 2022; 11. [PMID: 36555921 DOI: 10.3390/jcm11247304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a unique type of reversible cardiomyopathy that predominantly affects elderly women. The role of physical and emotional stress in the pathophysiology of TTS is well established. However, the association between preceding emotional triggers and clinical outcomes in stable patients has not yet been fully investigated. We aimed to investigate the association between emotional triggers before symptom onset and clinical outcomes in stable patients with TTS. METHODS This is a retrospective cohort study based on the data of patients with ICD-9 discharge diagnosis of TTS between 2017 and 2022. Patients were divided into two groups: with and without obvious emotional trigger before symptom onset. Demographic, laboratory, echocardiographic, and clinical outcomes were obtained and compared between the two groups. RESULTS We included 86 patients (93% were women, mean age 68.8 ± 12.3 years). Of them, 64 (74.4%) reported an emotional trigger before symptom onset. Patients with a previous emotional trigger had a longer hospital stay (4.3 + 2.0 days vs. 3.0 + 1.4, p = 0.002) with no difference in in-hospital complications (32.8% vs. 13.6%, p = 0.069), with no difference in 30-day mortality, readmissions, or recurrence rate between the groups. CONCLUSIONS Patients with TTS related to an emotional trigger may represent a different population from patients without a preceding trigger by having more symptomatic disease and longer hospital stay, yet with no difference in the 30-day outcomes.
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Bouwmeester RN, Bormans EM, Duineveld C, van Zuilen AD, van de Logt AE, Wetzels JF, van de Kar NC. COVID-19 vaccination and Atypical hemolytic uremic syndrome. Front Immunol 2022; 13:1056153. [PMID: 36531998 PMCID: PMC9755835 DOI: 10.3389/fimmu.2022.1056153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction COVID-19 vaccination has been associated with rare but severe complications characterized by thrombosis and thrombocytopenia. Methods and Results Here we present three patients who developed de novo or relapse atypical hemolytic uremic syndrome (aHUS) in native kidneys, a median of 3 days (range 2-15) after mRNA-based (Pfizer/BioNTech's, BNT162b2) or adenoviral (AstraZeneca, ChAdOx1 nCoV-19) COVID-19 vaccination. All three patients presented with evident hematological signs of TMA and AKI, and other aHUS triggering or explanatory events were absent. After eculizumab treatment, kidney function fully recovered in 2/3 patients. In addition, we describe two patients with dubious aHUS relapse after COVID-19 vaccination. To assess the risks of vaccination, we retrospectively evaluated 29 aHUS patients (n=8 with native kidneys) without complement-inhibitory treatment, who received a total of 73 COVID-19 vaccinations. None developed aHUS relapse after vaccination. Conclusion In conclusion, aHUS should be included in the differential diagnosis of patients with vaccine-induced thrombocytopenia, especially if co-occuring with mechanical hemolytic anemia (MAHA) and acute kidney injury (AKI). Still, the overall risk is limited and we clearly advise continuation of COVID-19 vaccination in patients with a previous episode of aHUS, yet conditional upon clear patient instruction on how to recognize symptoms of recurrence. At last, we suggest monitoring serum creatinine (sCr), proteinuria, MAHA parameters, and blood pressure days after vaccination.
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Affiliation(s)
- Romy N. Bouwmeester
- Radboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands,*Correspondence: Romy N. Bouwmeester,
| | - Esther M.G. Bormans
- Radboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands
| | - Caroline Duineveld
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands
| | - Arjan D. van Zuilen
- University Medical Center Utrecht, Department of Nephrology and Hypertension, Utrecht, Netherlands
| | - Anne-Els van de Logt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands
| | - Jack F.M. Wetzels
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, Netherlands
| | - Nicole C.A.J. van de Kar
- Radboud University Medical Center, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, Netherlands
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Mahamid A, Bornstein RJ, Amir H. Pfizer/BioNTech SARS-CoV-2 vaccine as a potential trigger for the development of narcolepsy: a case report. J Clin Sleep Med 2022; 18:2503-2506. [PMID: 35733336 PMCID: PMC9516586 DOI: 10.5664/jcsm.10134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022]
Abstract
Narcolepsy is a rare condition in Israel. Currently, the incidence of narcolepsy following SARS-CoV-2 vaccination in Israel is unknown. We are reporting a case report of a 51-year-old woman of Ashkenazi Jewish descent who was evaluated for complaints of excessive daytime sleepiness and relative functional decline that immediately followed receipt of the Pfizer/BioNTech SARS-CoV-2 vaccination. Evaluation of patient-reported data with polysomnography and multiple sleep latency test was consistent with narcolepsy with cataplexy, meeting the criteria for a diagnosis of type 1 narcolepsy. Further investigation included human leukocyte antigen testing. Prior studies have demonstrated genetic, immunological, and environmental factors associated with narcolepsy following other vaccinations. This case is a valuable contribution to the literature as there are no prior reports of type 1 narcolepsy following SARS-CoV-2 vaccination in the State of Israel. CITATION Mahamid A, Bornstein RJ, Amir H. Pfizer/BioNTech SARS-CoV-2 vaccine as a potential trigger for the development of narcolepsy: a case report. J Clin Sleep Med. 2022;18(10):2503-2506.
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Affiliation(s)
- Ala Mahamid
- Institute of Sleep Disorders, Loewenstein Rehabilitation Center, Raanana, Israel
| | - Robyn Jacob Bornstein
- Department of Outpatient Medical Rehabilitation, Loewenstein Rehabilitation Center, Raanana, Israel
| | - Hagay Amir
- Loewenstein Rehabilitation Medical Center, Raanana, Israel
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Canpolat U. Mechanistic vs. empirical ablation of atria during repeat ablation for atrial arrhythmias despite effective pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:2013-2014. [PMID: 35748389 DOI: 10.1111/jce.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
In this issue of the journal, Sciacca et al. (Ref) reported their single center experience in a small non-randomized observational study about the catheter ablation approach and outcomes in 74 patients with atrial arrhythmia reccurence [atrial fibrillation (AF) (36.5%) and atrial tachycardia (AT) (63.5%)] This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Arrhythmia and Electrophysiology Unit, Ankara, Turkey
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Anaya Y, Cakmak H, Mata DA, Letourneau J, Zhang L, Lenhart N, Juarez-Hernandez F, Jalalian L, Cedars MI, Rosen M. Triggering with 1,500 IU of human chorionic gonadotropin plus follicle-stimulating hormone compared to a standard human chorionic gonadotropin trigger dose for oocyte competence in in vitro fertilization cycles: a randomized, double-blinded, controlled noninferiority trial. Fertil Steril 2022; 118:266-278. [PMID: 35705380 DOI: 10.1016/j.fertnstert.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess if triggering with 1,500 IU of human chorionic gonadotropin (hCG) with 450 IU of follicle-stimulating hormone (FSH) induces noninferior oocyte competence to a standard dose of hCG trigger used in in vitro fertilization (IVF). The alternative trigger will be considered noninferior if it is at least 80% effective in promoting oocyte competence. DESIGN Randomized, double-blinded, controlled noninferiority trial. SETTING Academic infertility practice. PATIENTS Women aged 18-41 undergoing IVF with antral follicle count ≥8, body mass index ≤30 kg/m2, and no history of ≥2 IVF cycles canceled for poor response were enrolled. Participants with a serum estradiol >5,000 pg/mL on the day of trigger were excluded because of high risk of ovarian hyperstimulation syndrome. INTERVENTIONS Participants were randomized to receive an alternative trigger of 1,500 IU of hCG plus 450 IU of FSH or a standard trigger dose of hCG (5,000 or 10,000 IU) for final oocyte maturation. MAIN OUTCOME MEASURES The primary outcome was total competent proportion, defined as the probability of 2 pronuclei from an oocyte retrieved. The alternative trigger will be considered noninferior to the standard trigger if a 1-sided 95% confidence interval (CI) of the relative risk (RR) is not <0.8. Secondary outcomes included oocyte recovery and maturity, intracytoplasmic sperm injection fertilization, embryo quality, pregnancy rates, as well as serum and follicular hormones. Secondary outcomes were compared using a 2-sided superiority test. Outcomes were analyzed by intention-to-treat and per-protocol. RESULTS A total of 105 women undergoing IVF were randomized from May 2015 to June 2018. The probability of the primary outcome was 0.59 with the alternative trigger and 0.65 with the standard trigger, with a RR of 0.91 and a 1-sided 95% CI of 0.83. Noninferiority of the alternative trigger was demonstrated. Live birthrate from all fresh transfers in the alternative trigger group vs. standard trigger was 46.9 vs. 46.4% (RR, 1.01; 95% CI, 0.62-1.62), respectively. Live birthrate per randomized participant was 48.1% in the alternative trigger group vs. 62.7% with the standard trigger (RR, 0.73; 95% CI, 0.48-1.11). No participants had a failed retrieval. CONCLUSION Triggering with 1,500 IU of hCG plus 450 IU of FSH promoted noninferior oocyte competence compared to a standard hCG trigger dose. TRIAL REGISTRATION NCT02310919.
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Affiliation(s)
- Yanett Anaya
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California.
| | - Hakan Cakmak
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
| | - Douglas A Mata
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Letourneau
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California; Division of Reproductive Endocrinology and Infertility, Utah Center for Reproductive Medicine, University of Utah, Salt Lake City, Utah
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Nikolaus Lenhart
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
| | - Flor Juarez-Hernandez
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
| | - Liza Jalalian
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
| | - Mitchell Rosen
- Division of Reproductive Endocrinology and Infertility, Center for Reproductive Health, University of California San Francisco, San Francisco, California
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Vukovic‐Cvetkovic V, Schytz HW. Airplane flights triggering spontaneous intracranial hypotension: Observations from the Danish headache centre. Acta Neurol Scand 2022; 146:92-98. [PMID: 35502151 PMCID: PMC9321836 DOI: 10.1111/ane.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022]
Abstract
Objective Spontaneous intracranial hypotension (SIH) manifests as orthostatic headache, which can be confirmed by radiological signs of low intracranial pressure on magnetic resonance imaging of the brain. The most common mechanisms of SIH are ruptured meningeal diverticula, ventral dural tears and CSF‐venous fistulas. SIH is associated with connective tissue disorders, and cases of SIH onset after trivial trauma have been reported. As SIH is often underdiagnosed, the aim of this study is to identify possible new risk factors of SIH onset in a case series of SIH patients. Materials and methods We retrospectively reviewed the medical records of 36 patients diagnosed with SIH. We reviewed and identified potential factors that led to or presented at headache onset in SIH patients. Results We identified 4/36 (11%) patients that had a close temporal relationship between the onset of SIH symptoms and airplane travel. In all four patients, the clinical and imaging features confirmed the diagnosis of SIH. Conclusion This is the first report of a case series of four patients with SIH that could be related to airplane travel. Describing four cases (11%) is not proof but should alert us to a possible causal relationship, which calls for further research. We suggest that when taking medical history, thorough details about the patient's activities, such as headache onset, should be documented because of their importance in correctly diagnosing SIH, which is a debilitating, yet treatable, disease.
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Affiliation(s)
| | - Henrik W. Schytz
- Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Copenhagen Denmark
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Abstract
BACKGROUND The mask leak test used for modern noninvasive ventilators can detect the leak characteristics of masks that are not recommended by the manufacturer, but it has not yet been determined whether this method is acceptable. METHODS A noninvasive ventilator equipped with a single-limb circuit and an oronasal mask was connected to a lung simulator. The ventilator was set to S/T mode, and inspiratory positive airway pressure/expiratory positive airway pressure was set to 10/5, 15/5, and 20/5 cm H2O, respectively. Eight nonmanufacturer-recommended oronasal masks were connected to the ventilator. The lung simulator was used to simulate COPD, restrictive disease, and normal lung, respectively. When switching between masks, the mask leak test was set to "Cancel" or "Start Test" in the noninvasive ventilator. The parameters displayed on the lung simulator and ventilator were recorded before and after the mask leak test. RESULTS There were no significant difference before versus after the mask leak test for any lung simulator parameter, including trigger performance (ie, time from the beginning of the simulated inspiratory effort to the lowest value of airway pressure needed to trigger the ventilator, the magnitude of airway pressure drop needed to trigger, and time to trigger), inspiratory pressure delivery, PEEP, tidal volume, and displayed peak inspiratory pressure (all differences < 10%). At different noninvasive ventilation settings, tidal volumes displayed on the ventilator of the 3 masks were significantly different before and after mask leak test (all P < .05, and difference rate > 10%). CONCLUSIONS The mask leak test had no effect on the ventilator performance when masks not recommended by the manufacturer were used, but tidal volume monitoring may be more accurate when some masks were used.
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Affiliation(s)
- Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hai-Jia Hou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chang-Ling Lu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
| | - Hong-Wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Fanton M, Nutting V, Solano F, Maeder-York P, Hariton E, Barash O, Weckstein L, Sakkas D, Copperman AB, Loewke K. An interpretable machine learning model for predicting the optimal day of trigger during ovarian stimulation. Fertil Steril 2022:S0015-0282(22)00244-8. [PMID: 35589417 DOI: 10.1016/j.fertnstert.2022.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop an interpretable machine learning model for optimizing the day of trigger in terms of mature oocytes (MII), fertilized oocytes (2PNs), and usable blastocysts. DESIGN Retrospective study. SETTING A group of three assisted reproductive technology centers in the United States. PATIENT(S) Patients undergoing autologous in vitro fertilization cycles from 2014 to 2020 (n = 30,278). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Average number of MII oocytes, 2PNs, and usable blastocysts. RESULT(S) A set of interpretable machine learning models were developed using linear regression with follicle counts and estradiol levels. When using the model to make day-by-day predictions of trigger or continuing stimulation, possible early and late triggers were identified in 48.7% and 13.8% of cycles, respectively. After propensity score matching, patients with early triggers had on average 2.3 fewer MII oocytes, 1.8 fewer 2PNs, and 1.0 fewer usable blastocysts compared with matched patients with on-time triggers, and patients with late triggers had on average 2.7 fewer MII oocytes, 2.0 fewer 2PNs, and 0.7 fewer usable blastocysts compared with matched patients with on-time triggers. CONCLUSION(S) This study demonstrates that it is possible to develop an interpretable machine learning model for optimizing the day of trigger. Using our model has the potential to improve outcomes for many in vitro fertilization patients.
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Capron DW, Bauer BW, Bryan CJ. When people die by suicide: Introducing unacceptable loss thresholds as a potential missing link between suicide readiness states and actively suicidal clinical states. Suicide Life Threat Behav 2022; 52:280-288. [PMID: 34854497 DOI: 10.1111/sltb.12820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Contemporary models of suicide have largely overlooked why a person at high risk for suicide attempts suicide at a specific time. We propose the construct of unacceptable loss thresholds (i.e., a person's tolerance limit for a negative life event, which if violated results in an increase in suicide risk), which addresses many paradoxes in the literature related to suicide triggers. The aim of this paper is to provide preliminary proof of concept and to stimulate replication and further empirical study. METHODS We recruited an online community sample of individuals with a suicide attempt history (n = 144). These individuals answered questions about the time leading up to their most recent suicide attempt. RESULTS The majority (70.8% yes; 18.1% cannot remember; 11.1% no) reported creating a threshold of unacceptable loss, and that relatively small events were enough to trigger feelings that life was not worth living (63.9% yes; 30.6% maybe; 5.6% no). Further, the majority (57.6% yes; 21.5% yes, but only if asked; 20.8% - no) reported they would be willing to tell their therapist/doctor about their thresholds of unacceptable loss. CONCLUSION The construct of unacceptable loss deserves further empirical inquiry. Individuals contemplating suicide set them and if the loss occurs, it may trigger suicidal action in suicide ready individuals. Thresholds could provide risk assessment and safety planning data currently being overlooked.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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35
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Affiliation(s)
- Barbara Bailly-Caillé
- Department of Dermatology, Centre Hospitalier Universitaire Caen, Avenue de la cote de Nacre, 14033 Caen Cedex, France
| | - Fabienne Jouen
- Department of Immunology, Centre Hospitalier Universitaire Rouen, 1 rue de Germont, 76031 Rouen Cedex, France
| | - Anne Dompmartin
- Department of Dermatology, Centre Hospitalier Universitaire Caen, Avenue de la cote de Nacre, 14033 Caen Cedex, France
| | - Cécile Morice
- Department of Dermatology, Centre Hospitalier Universitaire Caen, Avenue de la cote de Nacre, 14033 Caen Cedex, France
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36
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Phartyal SS, Rosbakh S, Gruber M, Poschlod P. The sweet and musky scent of home: biogenic ethylene fine-tunes seed germination in wetlands. Plant Biol (Stuttg) 2022; 24:278-285. [PMID: 34990068 DOI: 10.1111/plb.13385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Wetlands are known for comparatively high production of biogenic ethylene from decomposed sediment. Because the gas has various well-documented effects on seed physiology, we asked whether it can be a vital seed germination cue for wetland plants. Specifically, we explored whether ethylene plays an ecological role in (i) breaking/weakening seed dormancy, (ii) broadening the germination niche width, (iii) promoting germination speed or (iv) altering the germination requirements of six plant species with different occurrence along a hydroperiod gradient. In a factorial experiment, both ethylene-treated and untreated seeds were incubated in combinations of temperature (constant versus fluctuating), illumination (light versus darkness) and oxygen (aerobic versus hypoxia) with and without cold stratification. Our results revealed seed exposure to ethylene did not weaken or break dormancy without cold stratification treatment. However, ethylene helped to broaden the germination niche width, increased overall germination percentage and speed of cold-stratified (non-dormant) seeds. This indicates that ethylene helps those seeds that lost dormancy (non-dormant) to sense favourable water-saturated versus flooded substrate depending on their requirement for aerobic versus hypoxic conditions to trigger germination. We conclude that ethylene does not interfere directly with the dormancy-breaking process in autumn-dispersed seeds that are naturally cold-stratified in winter and germinate in spring/summer. However, ethylene plays a crucial ecological role as a 'flood detector' for different wetland plant communities (reed, mudflat, swamp, shallow water) to synchronize germination of non-dormant seeds in the most suitable habitat at the right time.
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Affiliation(s)
- S S Phartyal
- Ecology and Conservation Biology, Institute of Plant Sciences, University of Regensburg, Regensburg, Germany
- School of Ecology and Environment Studies, Nalanda University, Rajgir, India
| | - S Rosbakh
- Ecology and Conservation Biology, Institute of Plant Sciences, University of Regensburg, Regensburg, Germany
| | - M Gruber
- Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany
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Czempik PF, Gierczak D, Wilczek D, Krzych ŁJ. The Impact of Red Blood Cell Transfusion on Blood Lactate in Non-Bleeding Critically Ill Patients-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11041037. [PMID: 35207310 PMCID: PMC8879325 DOI: 10.3390/jcm11041037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023] Open
Abstract
Anemia should preferably be managed without red blood cell transfusion (RBCT); instead, therapy should be focused on causes of anemia along with efforts to minimize blood loss. Lactate could potentially be used as a physiologic RBCT trigger, although there are some limitations to its interpretation. The aim of our study was to analyze the impact of RBCT on blood lactate with consideration of factors known to increase its concentration and to assess the usefulness of blood lactate as a potential physiologic RBCT trigger. We performed a retrospective analysis of all RBCT episodes in non-bleeding critically ill patients. We retrieved demographic data, data on RBCT itself (duration, type of RBC, volume of RBC, age of RBC), laboratory parameters (lactate, hemoglobin, glucose, total bilirubin), and factors potentially increasing lactate. We analyzed 77 RBCTs with elevated pre-RBCT lactate. The median age of patients was 66 (IQR 57–73) years and the distribution of sexes was even. The named factors potentially influencing lactate had no impact on its concentration. The median pre-post RBCT lactate was 2.44 (IQR 2.08–3.27) and 2.13 (IQR 1.75–2.88) mmol/L, respectively (p < 0.01); the median decrease was 0.41 (IQR 0.07–0.92) mmol/L. We conclude that RBCT did not normalize mildly elevated lactate. Common causes of elevated lactate probably had no impact on its concentration. Therefore lactate may have a limited role as a physiologic RBCT trigger in non-bleeding severely anemic critically ill patients.
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Affiliation(s)
- Piotr F. Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-7894201
| | - Dawid Gierczak
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (D.G.); (D.W.)
| | - Dawid Wilczek
- Students’ Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (D.G.); (D.W.)
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Liu L, Yu Y, Xu X, Sun Q, Qiu H, Chiumello D, Yang Y. Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation. Front Med (Lausanne) 2021; 8:752508. [PMID: 34869448 PMCID: PMC8632800 DOI: 10.3389/fmed.2021.752508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV. Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS10), 30% (PS30), 50% (PS50), and automatic adjustment PSV (PSAUTO). Patient-ventilator interactions were measured. Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PSAUTO when compared with PS10, PS30, and PS50, (P < 0.05). The benefit of PSAUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PSAUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PSAUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes. Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.
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Affiliation(s)
- Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yue Yu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoting Xu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qin Sun
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Davide Chiumello
- SC Anesthesia and Resuscitation, San Paolo Hospital-University Campus, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy.,Coordinated Research Center of Respiratory Insufficiency, University of Milan, Milan, Italy
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Qabalin MK, Naser M, Hawajreh WM, Abu-Zaideh S. GPS Week Number Rollover Timestamp Complement. Sensors (Basel) 2021; 21:s21237826. [PMID: 34883828 PMCID: PMC8659877 DOI: 10.3390/s21237826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Global Positioning System (GPS) is a global navigation satellite system and the most common satellite system used in navigation and tracking devices. The phenomenon of week number rollover happened recently—a year ago—due to a design limitation in the week number variable that counting weeks which causes vast losses. As many fleet management systems depend on GPS raw data, such systems stopped working due to inaccurate data provided by GPS receivers. In this paper, we propose a technical and mathematical analysis for the GPS week number rollover phenomenon and suggest a solution to avoid the resulting damage to other subsystems that depend on the GPS device’s raw data. In addition, this paper seeks to provide precautionary measures to deal with the problem proactively. The Open Systems Interconnection model (OSI) and transport layer level solution that has been suggested depends on a TCP packet reforming tool that re-formats the value of the week number according to a mathematical model based on a timestamp complement. At the level of the database, a solution is also suggested which uses triggers. A hardware-level solution is suggested by applying a timestamp complement over the GPS internal controller. Complete testing is applied for all suggested solutions using actual data provided by Traklink—a leading company in navigation and fleet management solutions. After testing, it is evident that the transport layer level solution was the most effective in terms of speed, efficiency, accuracy, cost, and complexity. Applying a transport layer level complement mathematical model can fix the consequences of GPS week number rollover and provide stability to all subsystems that used GPS data from infected devices.
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Affiliation(s)
- Majdi K. Qabalin
- Department of Computer Science, Princess Sumaya University for Technology, 1438 Al-Jubaiha, Amman 11941, Jordan; (M.N.); (S.A.-Z.)
- Engineering Department, Traklink Co., Amman 11941, Jordan;
- Correspondence: ; Tel.: +962-780177770
| | - Muawya Naser
- Department of Computer Science, Princess Sumaya University for Technology, 1438 Al-Jubaiha, Amman 11941, Jordan; (M.N.); (S.A.-Z.)
| | | | - Saja Abu-Zaideh
- Department of Computer Science, Princess Sumaya University for Technology, 1438 Al-Jubaiha, Amman 11941, Jordan; (M.N.); (S.A.-Z.)
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Abstract
Lyme disease (LD), also known as Lyme borreliosis, is a zoonotic disease caused by the Gram-negative bacteria Borrelia burgdorferi sensu lato belonging to the Spirochaetaceae family. Differentiating LD from other systemic disorders that present with musculoskeletal symptoms is challenging, and the presence of antibodies to borrelia in the general population may contribute to misdiagnosis. Moreover, long-term exposure of the host's immune system to spirochetes can contribute to the development of chronic autoimmune disease de novo. We report a 35-year-old woman with a combination of LD and systemic lupus erythematosus (SLE), and in this case, LD was the most likely trigger for SLE. We also performed a literature review and summarized the previously reported cases with a combination of LD and autoimmune disease.
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Affiliation(s)
| | - Svitlana Trypilka
- Rheumatologist Policlinic, Communal Non-Commercial Enterprise of Kharkov Regional Council "Regional Clinical Hospital", Kharkiv, UKR
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41
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Casagrande M, Forte G, Favieri F, Agostini F, Giovannoli J, Arcari L, Passaseo I, Semeraro R, Camastra G, Langher V, Pazzaglia M, Cacciotti L. The Broken Heart: The Role of Life Events in Takotsubo Syndrome. J Clin Med 2021; 10:4940. [PMID: 34768460 PMCID: PMC8585024 DOI: 10.3390/jcm10214940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/30/2023] Open
Abstract
The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be associated with some life events. This study focuses on clarifying life event characteristics and the role of triggers in the onset of TTS. Participants with TTS (n = 54) were compared to those with acute myocardial infarction (AMI; n = 52) and healthy individuals (n = 54). Using a modified version of the Interview for Recent Life Events, information about general life events perceived as stressful and triggers preceding the onset of a cardiac syndrome was collected. The assessment included the impact of these events as indicated by the participants and estimated by the interviewer; finally, the objective impact was considered. Although the number of events and the objective impact did not differ among the groups, patients with TTS reported a more negative perceived impact. Moreover, 61% of these patients objectively and subjectively reported a more stressful trigger before the onset of the disease (in the 24 h preceding the cardiac event) than those reported by patients with AMI. The dynamic between life events and individual responses could help differentiate TTS from other cardiovascular events, such as AMI. This study suggests that patients' perception of some life events (whether triggers or general life events) could represent a possible marker of TTS.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Agostini
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Jasmine Giovannoli
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Luca Arcari
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Ilaria Passaseo
- Divisione di Cardiologia, Policlinico Casilino, Via Casilina, 00169 Roma, Italy;
| | - Raffaella Semeraro
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Giovanni Camastra
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Viviana Langher
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Luca Cacciotti
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
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Shahidi Dadras M, Rakhshan A, Ahmadzadeh A, Hosseini SA, Diab R, Safari Giv T, Abdollahimajd F. Dermatomyositis-lupus overlap syndrome complicated with cardiomyopathy after SARS-CoV-2 infection: A new potential trigger for musculoskeletal autoimmune disease development. Clin Case Rep 2021; 9:e04931. [PMID: 34667608 PMCID: PMC8512177 DOI: 10.1002/ccr3.4931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 01/06/2023] Open
Abstract
COVID-19 should be considered as a new triggering factor for autoimmune disorders like DM-lupus overlap syndrome. We recommend that patients presenting with dermatomyositis during this pandemic be screened for COVID-19.
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Affiliation(s)
- Mohammad Shahidi Dadras
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Clinical Research Development UnitShohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Azadeh Rakhshan
- Department of PathologyShohada‐e Tajrish HospitalSchool of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Arman Ahmadzadeh
- Department of RheumatologyLoghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Ali Hosseini
- Medical InternStudent Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Reem Diab
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Toktam Safari Giv
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Abdollahimajd
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Clinical Research Development UnitShohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
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Deepak SA, Ramdoss S. The Life-Course Theory of Serial Killing: A Motivation Model. Int J Offender Ther Comp Criminol 2021; 65:1446-1472. [PMID: 33334220 DOI: 10.1177/0306624x20981030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Case studies were conducted on eight serial killers in India who were inmates in central prisons of Kerala and Tamil Nadu. The study is a pioneering one on serial killers in the locale of the study. All available information about the lives of offenders were collected through multiple sources, including in-depth interviews with serial killers in the prisons, interviews of relatives of the killers, surviving victims, Investigators, crime scene studies, etc. The collected data have been chronologically arranged to construct biographies of the offenders. The rich biographies were carefully analyzed to construct an inclusive motivation model that can explain the process of individuals evolving into serial killers from a life-course approach. The motivation in each of the eight cases was explained with the proposed motivation model. The constructed motivation model is unique from the existing models, which were mostly rigid and, therefore, not applicable to cases outside the studies. The model proposes three critical determinants for explaining the evolution of a person into a serial killer, "nature," "Deep Resting Life Factor," and "key Incidents." The study found a relatively short incident named "trigger" in the lives of six serial killers, which played a significant role in bringing out the dormant killer instinct and push the subjects toward the first murder. The comparative analysis of the motivation in different cases revealed that though there were recurring factors in the lives of serial killers, their interactions were more important than standalone factors. The study also found that there are no predetermined recipes for the making of a killer like some past researchers claimed.
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Affiliation(s)
| | - S Ramdoss
- University of Madras, Chennai, India
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44
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Abstract
Objectives: Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas. Design: A nationwide, retrospective postal survey with case-control design. All individuals suffering an MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual. Results: A total of 189 patients suffering an MI on Christmas Eve, Christmas Day, or Boxing Day, and 157 patients in the control group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (37% vs. 21%, p = .002), depression (21% vs. 11%, p = .024), and worry (26% vs. 10%, p < .001) compared to the control group. The food and sweets consumption was increased in both groups, but to a greater extent in the control group (33% vs. 50%, p = .002 and 32% vs. 43%, p = .031). There were no increases in quarrels, anger, economic worries, or reduced compliance with medication. Conclusions: Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly contributing to the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.
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Affiliation(s)
- Anneli Olsson
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Ida Thorén
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Sparv
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
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Seigerman D, McEntee RM, Matzon J, Lutsky K, Fletcher D, Rivlin M, Vialonga M, Beredjiklian P. Time to Improvement After Corticosteroid Injection for Trigger Finger. Cureus 2021; 13:e16856. [PMID: 34522494 PMCID: PMC8425109 DOI: 10.7759/cureus.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Trigger finger is a commonly occurring hand condition that presents with symptoms of pain, clicking, locking, and catching of the finger. A common non-operative management option is corticosteroid injection. The purpose of this study was to evaluate the short-term patient response to corticosteroid injections for trigger finger. Methods The patients of six fellowship-trained orthopedic hand surgeons who underwent a corticosteroid injection for trigger finger between June 2019 and October 2019 were invited to participate in this study. Patients were contacted by phone at one week, two weeks, and three weeks after the injection to complete a questionnaire regarding their pain and triggering symptoms. Medical records were also reviewed to collect basic demographic data. Results A total of 452 patients were included in the study. At the final follow-up, 82.4% of patients reported complete pain relief, 16.3% had partial relief, and 1.2% had no relief from their pain. For their triggering symptoms, 65.9% reported complete triggering relief, 30.4% had partial relief, and 3.5% had no triggering relief. It took an average of 6.6 days following injection for patients to experience complete pain relief, and an average of 8.1 days for patients to experience complete triggering relief. Conclusions This analysis found that most patients experience relief of pain and triggering at three weeks following corticosteroid injection. The majority of patients experienced some pain relief within the first week following corticosteroid injection, while improvement in triggering appeared to lag behind pain relief.
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Affiliation(s)
- Daniel Seigerman
- Orthopedic Surgery, Rothman Orthopedic Institute, New York City, USA
| | - Richard M McEntee
- Orthopedic Surgery, University of Kansas, Kansas City, USA.,Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Jonas Matzon
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
| | - Mason Vialonga
- Orthopedics, Rutgers Robert Wood Johnson University, New Brunswick, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopedic Institute, Philadelphia, USA
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Amorós S, Gálvez-Montón C, Rodríguez-Leor O, O'Callaghan JM. A Simple Low-Cost Electrocardiogram Synchronizer. Sensors (Basel) 2021; 21:5885. [PMID: 34502776 DOI: 10.3390/s21175885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
Electrocardiogram (ECG) synchronization is useful to avoid the effects of cardiac motion in medical measurements, and is widely used in standard medical imaging. A number of medical equipment include embedded commercial synchronizers. However, the use of independent synchronization modules is sometimes needed when several non-integrated instruments are used, or in the development of new medical instruments and procedures. We present a simple low-cost ECG synchronizer module based on an Arduino controller board that converts the ECG signal into a transistor-transistor-logic (TTL) one, allowing real-time medical measurements triggered at specific phases of the cardiac cycle. The device and conversion algorithm developed is optimized in vitro using synthetic and human ECG signals, and tested in vivo on three swine specimens. Error rates during the in vivo testing stage remain below the 2% of the cycles in all animals and critical false positives are less than 1%, which is sufficient for most applications. Possible algorithm updates are discussed if its performance needs to be improved.
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47
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Usmani M, Brumfield KD, Jamal Y, Huq A, Colwell RR, Jutla A. A Review of the Environmental Trigger and Transmission Components for Prediction of Cholera. Trop Med Infect Dis 2021; 6:tropicalmed6030147. [PMID: 34449728 PMCID: PMC8396309 DOI: 10.3390/tropicalmed6030147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022] Open
Abstract
Climate variables influence the occurrence, growth, and distribution of Vibrio cholerae in the aquatic environment. Together with socio-economic factors, these variables affect the incidence and intensity of cholera outbreaks. The current pandemic of cholera began in the 1960s, and millions of cholera cases are reported each year globally. Hence, cholera remains a significant health challenge, notably where human vulnerability intersects with changes in hydrological and environmental processes. Cholera outbreaks may be epidemic or endemic, the mode of which is governed by trigger and transmission components that control the outbreak and spread of the disease, respectively. Traditional cholera risk assessment models, namely compartmental susceptible-exposed-infected-recovered (SEIR) type models, have been used to determine the predictive spread of cholera through the fecal–oral route in human populations. However, these models often fail to capture modes of infection via indirect routes, such as pathogen movement in the environment and heterogeneities relevant to disease transmission. Conversely, other models that rely solely on variability of selected environmental factors (i.e., examine only triggers) have accomplished real-time outbreak prediction but fail to capture the transmission of cholera within impacted populations. Since the mode of cholera outbreaks can transition from epidemic to endemic, a comprehensive transmission model is needed to achieve timely and reliable prediction with respect to quantitative environmental risk. Here, we discuss progression of the trigger module associated with both epidemic and endemic cholera, in the context of the autochthonous aquatic nature of the causative agent of cholera, V. cholerae, as well as disease prediction.
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Affiliation(s)
- Moiz Usmani
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL 32603, USA; (M.U.); (Y.J.); (A.J.)
| | - Kyle D. Brumfield
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD 20742, USA; (K.D.B.); (A.H.)
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD 20742, USA
| | - Yusuf Jamal
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL 32603, USA; (M.U.); (Y.J.); (A.J.)
| | - Anwar Huq
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD 20742, USA; (K.D.B.); (A.H.)
| | - Rita R. Colwell
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD 20742, USA; (K.D.B.); (A.H.)
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD 20742, USA
- Correspondence:
| | - Antarpreet Jutla
- Geohealth and Hydrology Laboratory, Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL 32603, USA; (M.U.); (Y.J.); (A.J.)
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Crooms RC, Lin HM, Neifert S, Deiner SG, Brallier JW, Goldstein NE, Gal JS, Gelfman LP. Palliative Care Consultation for Hospitalized Patients with Primary and Secondary Brain Tumors at a Single Academic Center. J Palliat Med 2021; 24:1550-1554. [PMID: 34166114 DOI: 10.1089/jpm.2021.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Studies addressing palliative care delivery in neuro-oncology are limited. Objectives: To compare inpatients with brain tumors who received palliative care (through referral or trigger) with those receiving usual care. Design: Retrospective cohort study. Setting/Subjects: Inpatients with primary or secondary brain tumors who did or did not receive palliative care at a U.S. medical center. Measurements: Sociodemographic, clinical, and utilization characteristics were compared. Results: Of 1669 brain tumor patients, 386 (23.1%) received palliative care [nontrigger: 246 (14.7%); trigger: 140 (8.4%)] and 1283 (76.9%) received usual care. Nontrigger patients were oldest (mean age 65.0 years; trigger: 61.1 years; usual care: 55.5 years; p < 0.001); sickest at baseline (mean Elixhauser comorbidity index 3.76; trigger: 3.49; usual care: 1.84; p < 0.001); and had highest in-hospital death [34 (13.8%), trigger: 10 (7.1%), usual care: 7 (0.5%); p < 0.001] and hospice discharge [54 (22.0%), trigger: 18 (12.9%), usual care: 14 (1.1%); p < 0.001]. Conclusions: Trigger criteria may promote earlier palliative care referral, yet criteria tailored for neuro-oncology are undeveloped.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hung-Mo Lin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean Neifert
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacie G Deiner
- Dartmouth Hitchcock and Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Jess W Brallier
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jonathan S Gal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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Cuviello A, Yip C, Battles H, Wiener L, Boss R. Triggers for Palliative Care Referral in Pediatric Oncology. Cancers (Basel) 2021; 13:1419. [PMID: 33808881 DOI: 10.3390/cancers13061419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Palliative care (PC) can improve the quality of life for pediatric cancer patients, yet these services remain underutilized, with referrals occurring late in the disease course or not at all. We previously described the patient and family characteristics that diverse pediatric oncology providers agree should be high yield triggers for PC referral in pediatric cancer patients. The current study examined how often those triggers were associated with a completed PC consult for a cohort of 931 patients. We discovered that PC referrals occur very infrequently and patients with stated triggers often do not get referred. These findings help support the need for a screening tool to standardize PC integration and improve care. Abstract Palliative care (PC) integration into the care of pediatric oncology patients is growing in acceptance and has been shown to improve the quality of life of children with cancer. Yet timing for referrals and referral practices remain inconsistent, and PC remains underutilized. We conducted a retrospective chart review of pediatric oncology patients treated at an academic institution between January 2015 to November 2018. Data collected included demographics, disease and therapy characteristics, and consultation notes, specifically documenting existence of predetermined “high yield triggers” for PC consultation. Among 931 eligible patients the prevalence of PC consultation was 5.6% while approximately 94% of patients had at least 1 trigger for PC consultation. The triggers that more often resulted in PC consultation included: symptom management needs (98%; n = 51) high-risk disease (86%; n = 45), poor prognosis (83%; n = 43), multiple lines of therapy (79%; n = 41) and a documented ICU admission (67%; n = 35). Our findings suggest that the high yield triggers for palliative care consultation that pediatric oncologists identify as important are not translating into practice; incorporating these triggers into a screening tool may be the next step to improve early PC integration.
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Chongchitpaisan W, Wiwatanadate P, Tanprawate S, Narkpongphan A, Siripon N. Trigger of a migraine headache among Thai adolescents smartphone users: a time series study. Environ Anal Health Toxicol 2021; 36:e2021006-0. [PMID: 33730793 PMCID: PMC8207005 DOI: 10.5620/eaht.2021006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/31/2021] [Indexed: 01/03/2023] Open
Abstract
The study aims to investigate the effect of modern technology in the trigger of migraine headaches in high school students by using generalized estimating equation analysis. The prospective time series study was conducted in one hundred and forty-five smartphones using high school students in Chiang Mai Province who each completed a headache diary giving a total of 12,969 data entries. The smartphone output power was measured and recorded by a smartphone application. Smartphone use, sleep quality, anxiety, and depression also were assessed. Results revealed that the prevalence of repeated headache be 13.4% and migraine 16.9%. The migraine had the strongest association with hand-free device use and internet use, followed by age and anxiety. Furthermore, the strongest effect of smartphone output power in triggering a migraine was found at ≤ 1.79×10−5 and 1.80–1.99×10−5 mW ranges. Meanwhile, Lag_6 of daily smartphone output power exposure produced the migraine effect in a reverse dose-response manner. The smartphone electromagnetic radiation was a primary migraine trigger. The study results led to the recommendation to avoid triggers by use of smartphone talking with hand-free devices to prevent a recurrent migraine.
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Affiliation(s)
- Wanna Chongchitpaisan
- Institute of Occupational and Environmental Medicine, Department of Medical service, Ministry of Public Health, Thailand
| | | | - Surat Tanprawate
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nipapon Siripon
- Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
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