Arturo P Jaramillo, Mohamed Yasir, Nandhini Iyer, Sally Hussein, Vijay Prabhu Sn
Sudden cardiac death (SCD) is a condition that accounts for a high percentage of cardiovascular fatalities, with ventricular tachyarrhythmias being the most common cause. There are signs and symptoms of SCD that occur spontaneously without any warning and are deadly. Despite preventative efforts focusing on the use of subcutaneous implanted cardioverter defibrillators (S-ICD) in the highest-risk population categories, a high number of SCDs occur in the normal population and in people who do not have a documented cardiac condition...
August 2023: Curēus
Seung-Jae Joo
Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers' benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing...
August 2023: Acute and critical care
Tania Kümpfel, Katrin Giglhuber, Orhan Aktas, Ilya Ayzenberg, Judith Bellmann-Strobl, Vivien Häußler, Joachim Havla, Kerstin Hellwig, Martin W Hümmert, Sven Jarius, Ingo Kleiter, Luisa Klotz, Markus Krumbholz, Friedemann Paul, Marius Ringelstein, Klemens Ruprecht, Makbule Senel, Jan-Patrick Stellmann, Florian Then Bergh, Corinna Trebst, Hayrettin Tumani, Clemens Warnke, Brigitte Wildemann, Achim Berthele
This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity...
September 7, 2023: Journal of Neurology
Michał Braczkowski, Dariusz Soszyński, Alicja Sierakowska, Ryszard Braczkowski, Klaudia Kufel, Beata Łabuz-Roszak
Encephalitis is a condition with a variety of etiologies, clinical presentations, and degrees of severity. The causes of these disorders include both neuroinfections and autoimmune diseases in which host antibodies are pathologically directed against self-antigens. In autoimmune encephalitis, autoantibodies are expressed in the central nervous system. The incidence of this disease is approximately 4% of all reported cases of encephalitis. Autoimmune encephalitis can be induced by antibodies against neuronal surface antigens such as N-methyl-D-aspartate-activated glutamate receptors (NMDAR), α-amino-3-hydroxy-5-methyl-4-isoxazole propionate receptors (AMPAR) or gangliosides GQ1b, DPPX, CASPR2, LGI1, as well as by antibodies against neuronal intracellular antigens...
August 3, 2023: Diagnostics
Jozine M Ter Maaten, Iris E Beldhuis, Peter van der Meer, Jan A Krikken, Douwe Postmus, Jenifer E Coster, Wybe Nieuwland, Dirk J van Veldhuisen, Adriaan A Voors, Kevin Damman
Measurement of natriuresis has been suggested as a reliable, easily obtainable biomarker for assessment of the response to diuretic treatment in patients with acute heart failure (AHF). Here, to assess whether natriuresis-guided diuretic therapy in patients with AHF improves natriuresis and clinical outcomes, we conducted the pragmatic, open-label Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure trial, in which 310 patients (45% female) with AHF requiring treatment with intravenous loop diuretics were randomly assigned to natriuresis-guided therapy or standard of care (SOC)...
August 28, 2023: Nature Medicine
Stefanos Zafeiropoulos, Ioannis T Farmakis, Ioannis Milioglou, Ioannis Doundoulakis, Eiran Z Gorodeski, Stavros V Konstantinides, Lauren Cooper, Stavros Zanos, Stavros Stavrakis, Grigorios Giamouzis, Javed Butler, George Giannakoulas
BACKGROUND: Medical treatment for heart failure (HF) with preserved ejection (HFpEF) and with mildly reduced ejection fraction (HFmrEF) has weaker evidence compared with reduced ejection fraction, despite recent trials with an angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i). OBJECTIVES: We aimed to estimate the aggregate therapeutic benefit of drugs for HFmrEF and HFpEF. METHODS: We performed a systematic review of MEDLINE, CENTRAL, and Web of Science for randomized trials including patients with HF and left ventricular ejection fraction (LVEF) >40%, treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (analyzed together as renin-angiotensin system inhibitors [RASi]), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), digoxin, ARNI, and SGLT2i...
August 25, 2023: JACC. Heart Failure
Sergey V Barinov, Gian Carlo Di Renzo
BACKGROUND: Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. OBJECTIVE: This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014...
August 23, 2023: American Journal of Obstetrics and Gynecology
Erwin Yii, James Onggo, Ming Kon Yii
Mass closure with a continuous suture using large bite stitching technique has been widely accepted for midline laparotomy wound closures. However, emerging evidence suggests the use of small bite technique to reduce rates of incisional ventral hernia, surgical site infection (SSI) and burst abdomen. This meta-analysis aims to compare small versus large bite stitching techniques to assess complication rates in midline laparotomy wound closures. A comprehensive multi-database search (OVID EBM Reviews, OVID Medline, EMBASE, Scopus) was conducted from database inception to 11th October 2021 according to PRISMA guidelines...
August 29, 2023: Asian Journal of Surgery
Aris Liakos, Thomas Karagiannis, Ioannis Avgerinos, Konstantinos Malandris, Apostolos Tsapas, Eleni Bekiari
PURPOSE: Management of type 2 diabetes is advancing beyond glycemic control and is increasingly based on cardiovascular risk stratification. This review summarizes recent advances in the field and identifies existing knowledge gaps and areas of ongoing research. METHODS: A bibliographic search was carried out in PubMed for recently published cardiorenal outcome trials, relevant guidelines, and studies on antidiabetic agents in the pipeline. RESULTS: Findings from cardiovascular outcome trials support the use of glucagon-like peptide 1 (GLP-1) receptor agonists or sodium-glucose cotransporter 2 (SGLT-2) inhibitors for patients with established cardiovascular disease or multiple risk factors, although it as yet remains uncertain whether the benefits are transferable to patients at lower absolute cardiovascular risk...
September 13, 2023: Hormones: International Journal of Endocrinology and Metabolism
Daniel B Chastain, Megan Spradlin, Hiba Ahmad, Andrés F Henao-Martínez
Glucocorticoids are widespread anti-inflammatory medications used in medical practice. The immunosuppressive effects of systemic glucocorticoids and increased susceptibility to infections are widely appreciated. However, the dose-dependent model frequently used may not accurately predict the risk of infection in all patients treated with long-term glucocorticoids. In this review, we examine the risks of opportunistic infections (OIs) in patients requiring glucocorticoid therapy by evaluating the influence of the glucocorticoid dose, duration, and potency, combined with biological and host clinical factors and concomitant immunosuppressive therapy...
September 6, 2023: Clinical Infectious Diseases
Medha Barbhaiya, Stephane Zuily, Ray Naden, Alison Hendry, Florian Manneville, Mary-Carmen Amigo, Zahir Amoura, Danieli Andrade, Laura Andreoli, Bahar Artim-Esen, Tatsuya Atsumi, Tadej Avcin, Michael H Belmont, Maria Laura Bertolaccini, D Ware Branch, Graziela Carvalheiras, Alessandro Casini, Ricard Cervera, Hannah Cohen, Nathalie Costedoat-Chalumeau, Mark Crowther, Guilherme de Jesús, Aurelien Delluc, Sheetal Desai, Maria De Sancho, Katrien M Devreese, Reyhan Diz-Kucukkaya, Ali Duarte-García, Camille Frances, David Garcia, Jean-Christophe Gris, Natasha Jordan, Rebecca K Leaf, Nina Kello, Jason S Knight, Carl Laskin, Alfred I Lee, Kimberly Legault, Steve R Levine, Roger A Levy, Maarten Limper, Michael D Lockshin, Karoline Mayer-Pickel, Jack Musial, Pier Luigi Meroni, Giovanni Orsolini, Thomas L Ortel, Vittorio Pengo, Michelle Petri, Guillermo Pons-Estel, Jose A Gomez-Puerta, Quentin Raimboug, Robert Roubey, Giovanni Sanna, Surya V Seshan, Savino Sciascia, Maria G Tektonidou, Angela Tincani, Denis Wahl, Rohan Willis, Cécile Yelnik, Catherine Zuily, Francis Guillemin, Karen Costenbader, Doruk Erkan
OBJECTIVE: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS: This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard...
August 28, 2023: Annals of the Rheumatic Diseases
Helena J Teede, Chau Thien Tay, Joop J E Laven, Anuja Dokras, Lisa J Moran, Terhi T Piltonen, Michael F Costello, Jacky Boivin, Leanne M Redman, Jacqueline A Boyle, Robert J Norman, Aya Mousa, Anju E Joham
STUDY QUESTION: What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? SUMMARY ANSWER: International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. WHAT IS KNOWN ALREADY: The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from six continents; it is now used in 196 countries and is widely cited...
August 15, 2023: Journal of Clinical Endocrinology and Metabolism
Nikki Duong, Payal Kakadiya, Jasmohan S Bajaj
BACKGROUND & AIMS: Hepatorenal syndrome (HRS) can occur in patients with cirrhosis and ascites due to splanchnic vasodilation, renal hypoperfusion, and vasoconstriction. HRS is a diagnosis of exclusion and portends a poor prognosis, with upward of 80% mortality at 2 weeks without treatment. This review will highlight randomized controlled trials for HRS pharmacotherapy. METHODS: A PubMed review of randomized controlled trials conducted over the past 25 years was undertaken; 18 studies were included...
September 2023: Clinical Gastroenterology and Hepatology
Ali Vaeli Zadeh, Alan Wong, Andrew Carl Crawford, Elias Collado, Joshua M Larned
OBJECTIVES: To examine whether a fluid resuscitation strategy based on guidelines (at least 30 mL/kg IV crystalloids) vs. a restrictive approach with <30 mL/kg within three hours affects in-hospital mortality in patients with sepsis and a history of heart failure (HF). DATA SOURCES: On 03/07/2023, we searched Embase, PubMed, and Scopus for peer-reviewed papers and abstracts using the PRISMA guidelines. STUDY SELECTION: The language was limited to English...
August 9, 2023: American Journal of Emergency Medicine
My Blohm, Gabriel Sandblom, Lars Enochsson, Johanna Österberg
IMPORTANCE: Female surgeons are still in the minority worldwide, and highlighting gender differences in surgery is important in understanding and reducing inequities within the surgical specialty. Studies on different surgical procedures indicate equal results, or safer outcomes, for female surgeons, but it is still unclear whether surgical outcomes of gallstone surgery differ between female and male surgeons. OBJECTIVE: To examine the association of the surgeon's gender with surgical outcomes and operating time in elective and acute care cholecystectomies...
August 30, 2023: JAMA Surgery
Christopher J D Wallis, Angela Jerath, Khatereh Aminoltejari, Kirusanthy Kaneshwaran, Arghavan Salles, Natalie Coburn, Frances C Wright, Lesley Gotlib Conn, Zachary Klaassen, Amy N Luckenbaugh, Sanjana Ranganathan, Carlos Riveros, Colin McCartney, Kathleen Armstrong, Barbara Bass, Allan S Detsky, Raj Satkunasivam
IMPORTANCE: Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed. OBJECTIVE: To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries. DESIGN, SETTING, AND PARTICIPANTS: A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019...
August 30, 2023: JAMA Surgery
Linda P T Joosten, Sander van Doorn, Peter M van de Ven, Bart T G Köhlen, Melchior C Nierman, Huiberdina L Koek, Martin E W Hemels, Menno V Huisman, Marieke Kruip, Laura M Faber, Nynke M Wiersma, Wim F Buding, Rob Fijnheer, Henk J Adriaansen, Kit C Roes, Arno W Hoes, Frans H Rutten, Geert-Jan Geersing
Background: There is ambiguity whether frail patients with atrial fibrillation (AF) managed with vitamin K antagonists (VKAs) should be switched to a non-vitamin K oral anticoagulant (NOAC). Methods: We conducted a pragmatic, multicenter, open-label, randomized controlled superiority trial. Older AF patients living with frailty (age ≥75 years plus a Groningen Frailty Indicator (GFI) score ≥3) were randomized to switch from INR-guided VKA treatment to a NOAC or to continued VKA treatment. Patients with a glomerular filtration rate <30 mL/min/1...
August 27, 2023: Circulation
Cristina P Sousa, Filipa Sales, Francisco Teixeira, Daniel Seabra, Mariana Cunha
Prinzmetal angina (PA) is characterized by the development of reversible vasoconstriction of the coronary arteries, transient ischemic electrocardiographic changes in the ST segment, chest pain at rest, and prompt response to nitrates. Spasms of the coronary arteries can be precipitated during the perioperative period by an imbalance of vasodilator and vasoconstrictor factors of smooth muscle cells, which can lead to myocardial ischemia, cardiac arrhythmias, and death. Nevertheless, this is a relatively unrecognized topic, and literature is scarce about it...
July 2023: Curēus
Wagner Nedel, Marcio Manozzo Boniatti, Thiago Lisboa
PURPOSE OF REVIEW: To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients. RECENT FINDINGS: IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves...
August 31, 2023: Current Opinion in Critical Care
Charles F Minto, Talmage D Egan, Thomas W Schnider
No abstract text is available yet for this article.
August 31, 2023: Anesthesiology
2023-09-12 00:24:57
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