Time-weighted lactate as a predictor of adverse outcome in acute heart failure

The role of dynamic changes in lactate concentrations on prognosis in acute heart failure has been poorly investigated. The aim of this study was to explore the predictive value of 24 h time-weighted lactate (LACTW ) in patients with acute heart failure

The North American Layman’s Understanding of COVID-19: Are We Doing Enough?

Background: In the absence of an effective vaccine, public health policies are aimed at awareness, and education of the general public in order to contain the quickly spreading COVID-19 pandemic. Most of the recommended precautionary measures are dependent on human behaviors and therefore their effectiveness largely depends on peoples' perception and attitudes toward the disease. This study aimed to assess the level of knowledge, risk perception, and precautionary measures taken in response to COVID-19 in North America. Methods: In this cross-sectional observational study, an online survey targeted to North Americans focused on the public's knowledge of COVID-19, risk perception, and precautionary behaviors taken in response to this pandemic. Descriptive analyses were performed for the whole population and the subgroup analyses contrasted the differences between Americans and Canadians. Results: The cohort comprised 1,264 relatively young participants with an average age of 28.6 ± 9.8 years. The vast majority (>90%) were knowledgeable about COVID-19. Regarding risk perception, about a quarter assumed to be at less risk to contract the disease, and 42.8% considered themselves to be less contagious than others. While the vast majority avoided performing risky behaviors, only a small proportion (13.2%) wore a face mask—which is in line with the public health recommendations of the two countries at the time of data collection. Overall, a larger proportion of Canadian participants (55.8%) were satisfied with the performance of their national public health in response to the current pandemic, compared to their American counterparts (12.2%). Discussion: Data regarding the public's knowledge of COVID-19, risk perception, and behaviors in response to this pandemic is limited. The results of this study highlight that this relatively young and educated sample of North Americans had a high level of knowledge about COVID-19 and a large proportion of them were taking the precautionary measures against this pandemic. However, a significant number of individuals believe to be at less risk of contracting the disease compared to the general population. Educating the public that no one is safe from this disease, could play a role in further limiting risky behaviors and ultimately facilitating disease containment

Bibliometric Analysis of Early COVID-19 Research: The Top 50 Cited Papers

Introduction: The COVID-19 pandemic is rapidly evolving with the number of cases exponentially rising. The research scientific community has reacted promptly as evidenced by an outstanding number of COVID-19 related publications. As the number of scientific publications rapidly rises, there is a need to dissect the factors that lead to highly impactful publications. To that end, the present paper summarizes the characteristics of the top 50 cited COVID-19-related publications that emerged early during the pandemic. Methods: A systematic search of the Web of Science, Scopus, and Google Scholar was performed, using keywords related to COVID-19 and SARS-CoV-19. Two independent authors reviewed all the search results, screening for the top 50 cited COVID-19-related articles. Inclusion criteria comprised any publication on COVID-19 or the SARS-CoV-2 virus. Data extracted included the type of study, journal, number of citations, number of authors, country of publication, and study content. Results: As of May 29th, the top 50 cited articles were cited 63849 times during the last four months. On average, 14 authors contributed to each publication. Over half of the identified articles were published in only three journals. Furthermore, 42% and 26% of the identified articles were retrospective case series and correspondence/viewpoints, respectively, while only one article was a randomized controlled trial. In terms of content, almost half (48%) of the identified publications reported clinical/radiological findings while only seven out of the 50 articles investigated potential treatments. Conclusion: By highlighting the characteristics of the top 50 cited COVID-19-related articles, the authors hope to disseminate information that could assist researchers to identify the important topics, study characteristics, and gaps in the literature

Seroprevalence and molecular characterization of Mycobacterium bovis infection in camels (Camelus dromedarius) in the Delta region, Egypt

Aim: This study aimed to determine the prevalence rates of Mycobacterium infection in camel sera collected before slaughter and gross lesion tissue collected at postmortem (PM) using enzyme-linked immunosorbent assay (ELISA), bacteriological culture, and polymerase chain reaction (PCR). In addition, serum samples from humans who had occupational contact with camels were tested by ELISA and sputum sample by culture. Materials and Methods: ELISA was performed on serum samples antemortem. In addition, bacteriological culture and PCR were conducted after PM. Tuberculosis infection was identified in humans who had contact with camels using ELISA for serum samples and culture for sputum samples. Results: Tuberculous lesions were detected in 184 of 10,903 camels (1.7%). The ELISA results revealed that of the 184 examined camel serum samples, 124 (67.39%) were positive and all 20 camel serum samples that had no associated tuberculous lesions were negative. Moreover, only one of 48 (2.08%) human serum samples was positive by ELISA. Mycobacterial culture revealed 112 isolates from the 184 examined camel samples (60.87%), while human sputum sample cultures were all negative. PCR analysis identified the mpb70 gene in three of seven randomly tested samples. Conclusion: Gene sequencing was performed on two samples and the sequences were submitted to the National Center for Biotechnology Information GenBank (accession numbers MF990289 and MG59479). A phylogenetic tree was constructed based on the partial DNA sequences of the mpb70 gene; the similarity between the isolates was 98.1%. The similarities between the two isolates and the standard strains of Mycobacterium bovis in GenBank were 98.1% and 100%, respectively. Further investigation on the antemortem detection of M. bovis infection in camels is needed to decrease public risk

New drugs, therapeutic strategies, and future direction for the treatment of Pulmonary Arterial Hypertension

Despite recent advances in pulmonary arterial hypertension (PAH) treatment, this condition is still characterized by an extremely poor prognosis. In this review, we discuss the use of newly-approved drugs for PAH treatment with already known mechanisms of action (macitentan), innovative targets (riociguat and selexipag), and novel therapeutic approaches with initial up-front combination therapy. Secondly, we describe new potential signalling pathways and investigational drugs with promising role in the treatment of PAH

Development of Sedative Dexmedetomidine Sublingual In Situ Gels: In Vitro and In Vivo Evaluations

Intravenous dexmedetomidine (DEX) is currently approved by the FDA for the sedation of intubated patients in intensive care units to reduce anxiety and to augment postoperative analgesia. Bradycardia and hypotension are limitations associated with the intravenous administration of DEX. In this study, DEX sublingual in situ gels were developed and assessed for their pH, gelling capacity, viscosity, mucoadhesion and in vitro drug release. The optimized gelling system demonstrated enhanced mucoadhesion, superior gelling capacity, reasonable pH and optimal rheological profile. In vivo, compared to the oral solution, the optimal sublingual gel resulted in a significant higher rate and extent of bioavailability. Although the in situ gel had comparable plasma levels to those observed following intravenous administration, significant amelioration of the systemic adverse reactions were attained. As demonstrated by the hot plate method, a sustained duration of analgesia in rats was observed after sublingual administration of DEX gel compared to the intravenously administered DEX solution. Furthermore, no changes in systolic blood pressure and heart rate were recorded in rats and rabbits, respectively, after sublingual administration of DEX. Sublingual administration of DEX in situ gel provides a promising approach for analgesia and sedation, while circumventing the reported adverse reactions associated with intravenous administration of DEX

Causes and outcomes of ICU hospitalisations in patients with pulmonary arterial hypertension

Rationale Pulmonary arterial hypertension (PAH) is a rare disease characterised by limited survival despite remarkable improvements in therapy. The causes, clinical burden and outcomes of patients admitted to the intensive care unit (ICU) remain poorly characterised. The aim of this study was to describe patient characteristics, causes of ICU hospitalisation, and risk factors for ICU and 1-year mortality. Methods Data from patients enrolled in the Johns Hopkins Pulmonary Hypertension Registry were analysed for the period between January 2010 and December 2020. Clinical, functional, haemodynamic and laboratory data were collected. Measurements and main results 102 adult patients with 155 consecutive ICU hospitalisations were included. The leading causes for admission were right heart failure (RHF, 53.3%), infection (17.4%) and arrhythmia (11.0%). ICU mortality was 27.1%. Mortality risk factors included Na <136 mEq·mL−1 (OR: 3.10, 95% CI: 1.41–6.82), elevated pro-B-type natriuretic peptide (proBNP) (OR: 1.75, 95% CI: 1.03–2.98), hyperbilirubinaemia (OR: 1.40, 95% CI: 1.09–1.80), hyperlactaemia (OR: 1.42, 95% CI: 1.05–1.93), and need for vasopressors/inotropes (OR: 5.29, 95% CI: 2.28–12.28), mechanical ventilation (OR: 3.76, 95% CI: 1.63–8.76) and renal replacement therapy (OR: 5.57, 95% CI: 1.25–24.76). Mortality rates at 3, 6 and 12 months were 17.5%, 27.6% and 39.0%, respectively. Connective tissue disease-associated PAH has lower 1-year survival compared to idiopathic PAH (51.4% versus 79.8%, log-rank test p=0.019). Conclusions RHF is the most common cause for ICU admission. In-hospital and 1-year mortality remain exceedingly high despite improved ICU care. Recognising specific risk factors on admission can help identifying patients at risk for poor outcomes