Comparing the Incidence of Propranolol and Esmolol-Related Cardiac Arrest in Patients With Thyroid Storm: A Systematic Literature Review

A precarious complication of thyrotoxicosis, or thyroid storm, is the increased risk of cardiomyopathy, which leads to circulatory collapse and cardiopulmonary arrest. It is crucial to promptly identify this condition to prevent significant deterioration of the left ventricular function and cardiogenic shock. This article seeks to examine published research that emphasizes the connection between thyroid storm and beta-blocker usage in relation to cardiogenic collapse and provides management recommendations. The search was performed on September 9, 2022, using PubMed, Science Direct, and Google Scholar libraries. A systematic exploration was carried out using the keywords Thyroid Storm AND cardiogenic Shock AND cardiac arrest AND beta blocker. The use of beta blockers as part of thyroid storm management was linked to the development of cardiogenic collapse and cardiac arrest. Ultra-short-acting beta-blockers like esmolol were a safer option than propranolol in treating patients with a thyrotoxic storm.

Common Sleep Disorders in Patients With Chronic Kidney Disease: A Systematic Review on What They Are and How We Should Treat Them

Chronic kidney disease (CKD) causes various complications that significantly impact a patient's overall well-being and quality of life. Sleep disorders are a particularly common issue, especially in patients with advanced disease. This systematic review aims to explore the distinguishing features, prevalence rates, underlying causes, and associated factors related to the most frequent sleep disorders in these patients and present the latest treatment methods for them. It also investigates the link between CKD and sleep disorders and presents the results of the most common sleep disorders found in patients with CKD. Four major sleep disorders have been identified: sleep apnea, restless leg syndrome, excessive drowsiness, and insomnia. These sleep disorders have been discovered to be highly common in CKD patients and have a major influence on their quality of life and morbidity.

A Systematic Review of the Association of Internet Gaming Disorder and Excessive Social Media Use With Psychiatric Comorbidities in Children and Adolescents: Is It a Curse or a Blessing?

Internet gaming and social media usage (SMU), particularly among children and teenagers, have witnessed a remarkable surge over the past decade. However, it remains uncertain whether this widespread usage has a positive or negative impact. The primary objective of this systematic review was to investigate the diverse effects of excessive video game playing and extensive SMU, both favorable and detrimental, on the psychological and mental well-being of children and adolescents. To assess the influence of internet gaming disorder (IGD) and disordered SMU on the mental health of children aged 6-12 years and adolescents aged 13-18 years, we conducted a systematic review of 20 studies on the subject. These studies utilized a substantial sample size of 48,652 participants, encompassing online and in-person questionnaires administered to children, teenagers, and their parents in educational institutions, healthcare facilities, and online platforms. Our findings suggest that multiple factors contribute to the intricate relationship between SMU, video game playing, and mental health outcomes. The majority of research indicates that excessive gaming or SMU among children and teenagers leads to adverse consequences on their mental well-being. Furthermore, certain studies have even reported fatal consequences, while others have identified a worsening of preexisting mental health issues. A few studies have explored the potential positive impacts of SMU and gaming on individuals and society at large. In light of this, we have concluded that it is inappropriate to categorize internet gaming and SMU as solely beneficial or detrimental without considering the broader context and the interplay of various factors.

A Systematic Review: Do the Use of Machine Learning, Deep Learning, and Artificial Intelligence Improve Patient Outcomes in Acute Myocardial Ischemia Compared to Clinician-Only Approaches?

Cardiovascular diseases (CVDs) present a significant global health challenge and remain a primary cause of death. Early detection and intervention are crucial for improved outcomes in acute coronary syndrome (ACS), particularly acute myocardial infarction (AMI) cases. Artificial intelligence (AI) can detect heart disease early by analyzing patient information and electrocardiogram (ECG) data, providing invaluable insights into this critical health issue. However, the imbalanced nature of ECG and patient data presents challenges for traditional machine learning (ML) algorithms in performing unbiasedly. Investigators have proposed various data-level and algorithm-level solutions to overcome these challenges. In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and to highlight the difficulties of utilizing ML, deep learning (DL), and AI algorithms in predicting, diagnosing, and prognosis of heart diseases. We reviewed 181 articles from reputable journals published between 2013 and June 15, 2023, focusing on eight selected papers for in-depth analysis. The analysis considered factors such as heart disease type, algorithms used, applications, and proposed solutions and compared the benefits of algorithms combined with clinicians versus clinicians alone. This systematic review revealed that the current ML-based diagnostic approaches face several open problems and issues when implementing ML, DL, and AI in real-life settings. Although these algorithms show higher sensitivities, specificities, and accuracies in detecting heart disease, we must address the ethical concerns while implementing these models into clinical practice. The transparency of how these algorithms operate remains a challenge. Nevertheless, further exploration and research in ML, DL, and AI are necessary to overcome these challenges and fully harness their potential to improve health outcomes for patients with AMI.

ID: 112: ROLE OF PHOSPHOLIPASE D IN IDIOPATHIC PULMONARY FIBROSIS

Idiopathic pulmonary fibrosis (IPF) is a deadly interstitial disease that leads to scarring and fibrosis of the lung tissue. In pulmonary fibrosis, there is injury and denudation of the alveolar epithelium, which further leads to activation of fibroblasts which differentiate into myofibroblasts. This includes several mechanisms including epithelial to mesenchymal transition (EMT). In this study, we investigated the role of phospholipase D (PLD) in IPF and also its underlying mechanism like EMT and fibroblast proliferation and differentiation. An in vivo murine model of bleomycin-induced pulmonary fibrosis (PF) and in vitro models of murine alveolar type-II epithelial cells (MLE-12) and human lung fibroblasts were used. C57BL/6 and genetically engineered PLD2−/− mice were intratracheally challenged with bleomycin (1.5 U/kg animal) for 14 days and markers of inflammation, EMT and fibrosis were determined. MLE-12 cells were treated with specific PLD1 or PLD2 inhibitors prior to bleomycin (10 mU/ml) challenge, and the role of PLD in EMT and apoptosis of alveolar epithelial cells was studied. Human lung fibroblasts were serum-starved (3h), pretreated with PLD1 or PLD2 inhibitors, and the effect of TGF-β (5 ng/ml) on differentiation of lung fibroblast to myofibroblast was determined. Intra-tracheal instillation of bleomycin in the mice for 14 days leads to the progression of fibrosis in the lung. The lung tissues of the bleomycin treated mice were found to have increased PLD2 protein expression, myofibroblast markers like α-SMA, fibronectin, mesenchymal markers like vimentin, inflammatory cytokines and collagen. Genetic deletion of PLD2 in mice attenuated bleomycin-induced lung inflammation and pulmonary fibrosis. In vitro, MLE-12 cells pretreated with either PLD1 or PLD2 inhibitor did not show a profound reduction either in apoptosis or the expression of transcription factors such as SNAIL, and other markers of EMT. However, MLE-12 cells pretreated with both PLD1 (250 nM) and PLD2 (500 nM) inhibitors were resistant to bleomycin-induced apoptosis, and exhibited reduced expression of SNAIL and mesenchymal markers. On the contrary, human lung fibroblasts pretreated with PLD1 and PLD2 inhibitors showed increased fibroblast to myofibroblast differentiation mediated by TGF-β. The present study suggests a role for PLD2 in bleomycin-induced PF. In vitro, inhibition of both PLD1 and PLD2 was necessary to attenuate bleomycin-induced EMT in epithelial cells and TGF-β mediated differentiation of fibroblasts to myofibroblasts. The in vivo and in vitro results identify the mechanism by which PLD regualtes PF and suggest PLD as a potential therapeutic target in pulmonary fibrosis. This work was supported by National Institutes of Health grant P01 HL98050 to VN.

Maximally recommended doses of angiotensin-converting enzyme (ACE) inhibitors do not completely prevent ACE-mediated formation of angiotensin II in chronic heart failure

BACKGROUND

The added benefits of angiotensin II type I receptor (AT(1)) blockers (ARBs) to ACE inhibition suggests that recommended doses of ACE inhibitors provide only partial inhibition of ACE in chronic heart failure (CHF). Accordingly, the level of ACE inhibition was assessed by the pressor response to angiotensin (Ang) I in patients who had been treated with recommended doses of ACE inhibitors.

METHODS AND RESULTS

Forty-two patients with CHF receiving 40 mg/d of a long-acting ACE inhibitor or 150 mg of captopril were studied. Radial artery systolic pressure (RASP, mm Hg) was monitored noninvasively. The pressor response to ascending doses of Ang I was evaluated in all patients before and after administration of the ARB valsartan. The pressor response to Ang I before and after valsartan was also reevaluated in 11 patients after the dose of ACE inhibitor was doubled for 1 week. RASP increased linearly with significantly ascending doses of Ang I despite treatment with ACE inhibitors. The pressor response to Ang I was blunted significantly by valsartan. Ang I-induced increase in RASP did not correlate with duration of ACE inhibitor therapy. After the dose of ACE inhibitors was doubled, the pressor response to Ang I was no longer different from that noted after valsartan.

CONCLUSIONS

Recommended doses of ACE inhibitors do not fully inhibit ACE in CHF. The level of ACE inhibition achieved is not related to duration of ACE inhibitor therapy. Greater ACE inhibition is also achieved at twice the recommended doses of ACE inhibitors.