Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension

PURPOSE OF REVIEW: The association between mental health, pain, and treatment-resistant hypertension is an important consideration for treating physicians. We review and discuss the connection between conditions of anxiety, depression, and chronic pain and their effect on uncontrolled hypertension. RECENT FINDINGS: There is significant co-occurrence of hypertension with anxiety, depression, and chronic pain which may lead to undertreatment of hypertension and undertreatment of the underlying mental health disorder. The association between mental health and hypertension is complex and is modulated by physiologic and environmental factors. Physicians treating patients with hypertension should be cognizant of the role anxiety, depression, and chronic pain play in treatment efficacy and compliance. Patients undergoing treatment should be screened for mental health disorders at treatment initiation and frequently thereafter to ensure optimal overall health and compliance

Prehospital Tibial Intraosseous Drug Administration is Associated with Reduced Survival Following Out of Hospital Cardiac Arrest: A study for the CARES Surveillance Group

BACKGROUND: Recent reports have questioned the efficacy of intraosseous (IO) drug administration for out-of-hospital cardiac arrest (OHCA) resuscitation. Our aim was to determine whether prehospital administration of resuscitative medications via the IO route was associated with lower rates of return of spontaneous circulation (ROSC) and survival to hospital discharge than peripheral intravenous (IV) infusion in the setting of OHCA. METHODS: We obtained data on all OHCA patients receiving prehospital IV or IO drug administration from the three most populous counties in Michigan over three years. Data was from the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) database. The association between route of drug administration and outcomes was tested using a matched propensity score analysis. RESULTS: From a total of 10,626 OHCA patients, 6869 received parenteral drugs during their prehospital resuscitation (37.8% by IO) and were included in analysis. Unadjusted outcomes were lower in patients with IO vs. IV access: 18.3% vs. 23.8% for ROSC (p \u3c 0.001), 3.2% vs. 7.6% for survival to hospital discharge (p \u3c 0.001), and 2.0% vs. 5.8% for favorable neurological function (p \u3c 0.001). After adjustment, IO route remained associated with lower odds of sustained ROSC (OR 0.72, 95% CI 0.63-0.81, p \u3c 0.001), hospital survival (OR 0.48, 95% CI 0.37-0.62, p \u3c 0.001), and favorable neurological outcomes (OR 0.42, 95% CI 0.30-0.57, p \u3c 0.001). CONCLUSION: In this cohort of OHCA patients, the use of prehospital IO drug administration was associated with unfavorable clinical outcomes

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

AfriMTE and AfriCOMET : Empowering COMET to Embrace Under-resourced African Languages

Despite the progress we have recorded in scaling multilingual machine translation (MT) models and evaluation data to several under-resourced African languages, it is difficult to measure accurately the progress we have made on these languages because evaluation is often performed on n-gram matching metrics like BLEU that often have worse correlation with human judgments. Embedding-based metrics such as COMET correlate better; however, lack of evaluation data with human ratings for under-resourced languages, complexity of annotation guidelines like Multidimensional Quality Metrics (MQM), and limited language coverage of multilingual encoders have hampered their applicability to African languages. In this paper, we address these challenges by creating high-quality human evaluation data with a simplified MQM guideline for error-span annotation and direct assessment (DA) scoring for 13 typologically diverse African languages. Furthermore, we develop AfriCOMET, a COMET evaluation metric for African languages by leveraging DA training data from high-resource languages and African-centric multilingual encoder (AfroXLM-Roberta) to create the state-of-the-art evaluation metric for African languages MT with respect to Spearman-rank correlation with human judgments (+0.406)

Situs Inversus: Inferior-Lateral ST-Elevation Myocardial Infarction on Right-Sided Electrocardiogram

Dextrocardia is a rare anatomical anomaly in which the heart is located in the patient’s right hemithorax with its apex directed to the right. Although it usually does not pose any serious health risks, patients with undiagnosed dextrocardia present a diagnostic challenge especially in those presenting with chest pain. Traditional left-sided electrocardiograms (ECG) inadequately capture the electrical activity of a heart positioned in the right hemithorax, which if unnoticed could delay or even miss an acute coronary syndrome diagnosis. Here, we present a case of a patient with dextrocardia presenting with chest pain and diagnosed with ST-elevation myocardial infarction using a right-sided ECG

Emergency Department Triage Blood Glucose Levels: Outcomes Implications in Patients with Severe Sepsis and Septic Shock

Background: Patients with severe sepsis and septic shock often present with a variety of organ dysfunctions including metabolic derangements. The appropriate metabolic stress response in sepsis includes release of glucose leading to stress-hyperglycemia and is commonly seen in these Emergency Department (ED) patients. Many studies focus on metabolic glucose abnormalities and its effect on outcomes at the time of Intensive Care Unit (ICU) admission. Hyperglycemia present on ICU admission has been associated with adverse outcomes irrespective of the presence or absence of diabetes mellitus. Methods: We analyzed our ED quality sepsis database in concern to triage glucose levels and associated 30 day mortality from August 2015 to October 2016 to determine adjustments in active glucose monitoring in the ED. Results: We identified 683 patients with severe sepsis (N=399) and septic shock (N=284). Average glucose levels at the 1stED laboratory evaluation was 172 mg/ dL (SD=149). Patients with septic shock had on average lower glucose levels (170 mg/dL) than patients with severe sepsis (174 mg/dL). Sepsis survivors had higher triage glucose (176 mg/dL, N=525) than non-survivors (159 mg/dL, N=157). When stratifying patients by glucose levels, we found that patients with glucose levels less than 70 mg/dL at ED triage had the highest mortality. The incidence of glucose of ≤ 70 mg/ dL was 7% (N=49) for all patients with severe sepsis and septic shock combined. The mortality in this group was 44% (21/49) which was significantly (p=0.001) higher than mortality in patients with higher glucose levels (136/634, 21%). In patients with glucose levels of ≥ 180 mg/dL the mortality was not different (35/177, 26%, p=0.9) when compared to patients with glucose levels ranging from 70-180 mg/dL. Conclusion: Glucose monitoring for patients with sepsis in the ED aids recognition of correctable metabolic derangements early in management. In the ED, the metabolic-stress response to sepsis is commonly stress-hyperglycemia, but hypoglycemia can also occur in the early phases of sepsis. Hypoglycemia at ED triage has a higher than expected mortality and needs to be recognized and treated accordingly

Efficacy of Olea europaea leaves and propolis extracts in the control of experimentally induced infectious bronchitis in broiler chickens

Infectious bronchitis (IB) is a viral disease that causes serious economic losses in the broiler industry. This study evaluated the effectiveness of Olea europaea leaves and propolis extracts (OLP) mixture at a rate of 400 μg and 100 mg/mL, respectively, in curing IB in broiler chickens. One-day-old Ross broiler chicks were randomized into four groups (G) of twenty-one chicks; G1 (control negative; no infection and treatment); G2 (no infection, treatment only), G3 (control positive; infection only and no treatment) and G4 (infection and treatment) that infected with IBv (106 EID50/ml) at 21 days old. The OLP treatment was applied for birds in G2 and G4 at a dose of 0.5 mL/liter drinking water for three successive days. The growth performance, clinical and pathological examinations, and viral shedding were evaluated. The use of the OLP resulted in protection from IB infection through the significant improvement of performance parameters such as weight gain and feed conversion ratio, decrease in mortality rate, lowering disease severity, and rapid recovery from the observed clinical signs (mainly respiratory signs), gross and microscopic lesions in the trachea, lung, and kidneys as compared to those in the positive control (G3). Moreover, the viral shedding in the OLP-treated chicks (G4) was significantly decreased in tracheal and cloacal swabs to a rate less than 3×103 IBv genome copy number and became not detectable at 14-days post-infection (dpi) in their cloacal swabs. In conclusion, OLP can potentially display an antiviral effect against IB in broiler chickens. Therefore, adding OLP to the chicken drinking water is recommended to prevent and control IB [Ger. J. Vet. Res. 2023; 3(2.000): 1-10

Acute coronary syndrome prediction in emergency care: A machine learning approach

BACKGROUND AND OBJECTIVE: Clinical concern for acute coronary syndrome (ACS) is one of emergency medicine\u27s most common patient encounters. This study aims to develop an ensemble learning-driven framework as a diagnostic support tool to prevent misdiagnosis. METHODS: We obtained extensive clinical electronic health data on patient encounters with clinical concerns for ACS from a large urban emergency department (ED) between January 2017 and August 2020. We applied an analytical framework equipped with many well-developed algorithms to improve the data quality by addressing missing values, dimensionality reduction, and data imbalance. We trained ensemble learning algorithms to classify patients with ACS or non-ACS etiologies of their symptoms. We used performance evaluation metrics such as accuracy, sensitivity, precision, F1-score, and the area under the receiver operating characteristic (AUROC) to measure the model\u27s performance. RESULTS: The analysis included 31,228 patients, of whom 563 (1.8%) had ACS and 30,665 (98.2%) had alternative diagnoses. Eleven features, including systolic blood pressure, brain natriuretic peptide, chronic heart disease, coronary artery disease, creatinine, glucose, heart attack, heart rate, nephrotic syndrome, red cell distribution width, and troponin level, are reported as significantly contributing risk factors. The proposed framework successfully classifies these cohorts with sensitivity and AUROC as high as 86.3% and 93.3%. Our proposed model\u27s accuracy, precision, specificity, Matthew\u27s correlation coefficient, and F1-score were 85.7%, 86.3%, 93%, 80%, and 86.3%, respectively. CONCLUSION: Our proposed framework can identify early patients with ACS through further refinement and validation

Rapamycin Improves Adipose-Derived Mesenchymal Stem Cells (ADMSCs) Renoprotective Effect against Cisplatin-Induced Acute Nephrotoxicity in Rats by Inhibiting the mTOR/AKT Signaling Pathway

Objective: Because the poor survival of transplanted cells in a hostile microenvironment limits stem cell therapy, in the current study, we investigated the effect of rapamycin (Rapa)-preactivated autophagy on the survival and homing of transplanted adipose mesenchymal stem cells (ADMSCs) in a rat model of cisplatin (Cis)-induced nephrotoxicity, as well as the possible role of the mTOR/AKT signaling pathway. Materials and methods: In vitro, ADMSCs isolated from rats were treated with 50 nmol/L rapamycin for 2 h, after which the cytoprotective and autophagy-inducing effects of Rapa were investigated. The cis-induced acute nephrotoxicity rat model was constructed in vivo. ADMSCs and Rapa-ADMSCs were administered into the tail vein before Cis therapy. At 3, 7, and 10 days after Cis injection, all animals were euthanized. The renal functions and morphology as well as autophagy response were assessed. Results: The pretreatment of cultured ADMSCs with Rapa caused a significant increase in autophagic activities and lysosome production of the cells, with a significant increase in the secretion of SDF-1, IL-10 and autophagy promoter LC3 and Beclin from these cells, while mTOR/AKT pathways were inhibited. In addition, the transplantation of Rapa-pretreated ADMSCs restored the kidney functions and morphology dramatically. Renal expression of SDF-1 and HIF1 was upregulated, while expression of IL-6, NF-kB and TGF-β1 was downregulated. Conclusions: We concluded that the preactivation of autophagy with Rapa improves the survival and differentiation of the transplanted ADMSCs by inhibiting the mTOR/AKT signaling pathway, which in turn could significantly attenuate the Cis-induced acute renal injury