“\u3cem\u3eThere is no pandemic\u3c/em\u3e”: On Memes, Algorithms and other Interpassive Forms of Right-wing Disbelief

This essay examines several prominent memes that have circulated on Right-wing social media during the Covid-19 pandemic. The memes coordinate what I describe as a mode of interpassive humor, which positions those who “believe” in the crisis as naïve dupes, infantilizing those subjects who have fallen prey to the idea that they should take the pandemic seriously, and thereby delegating fearfulness to the other so that reactionary Covid-19 denialists may continue with their lives unaffected. The essay thereby seeks to draw suggestive lines of affiliation between studies of digital memes, evolutionary mimetics, and psychoanalytic theory, pointing to the algorithmic spread of disinformation during the coronavirus pandemic as a case of interpassive humor

Plasmodium cellular effector mechanisms and the hepatic microenvironment

Plasmodium falciparum malaria remains one of the most serious health problems globally. Immunization with attenuated parasites elicits multiple cellular effector mechanisms capable of eliminating Plasmodium liver stages. However, malaria liver stage immunity is complex and the mechanisms effector T cells use to locate the few infected hepatocytes in the large liver in order to kill the intracellular liver stage parasites remain a mystery to date. Here, we review our current knowledge on the behavior of CD8+ effector T cells in the hepatic microvasculature, in malaria and other hepatic infections. Taking into account the unique immunological and lymphogenic properties of the liver, we discuss whether classical granule-mediated cytotoxicity might eliminate infected hepatocytes via direct cell contact or whether cytokines might operate without cell-cell contact and kill Plasmodium liver stages at a distance. A thorough understanding of the cellular effector mechanisms that lead to parasite death hence sterile protection is a prerequisite for the development of a successful malaria vaccine to protect the 40% of the world’s population currently at risk of Plasmodium infection

Blood pressure variability: Epidemiological and clinical issues

Blood pressure variability (BPV) is a classical physiological phenomenon. This paper describesmajor epidemiological and clinical issues of BPV which may be important to understand thebackground of this interesting feature. In healthy subjects, BPV is a measure of hemodynamiccondition and refl ects function of autonomic nervous system. BP fl uctuations result from thecomplex interaction between environmental stimulation, genetic factors and cardiovascularcontrol mechanisms. Abnormal BPV is recognized in persons with a blurred dipping pattern(i.e. extreme dipping, non-dipping, reverse-dipping, morning surge of BP) or increased variationsof day-time or night-time BP (high BP lability). Inappropriate BPV worsens the outcome,including increase in all-cause and cardiac mortality and incidence of cardiovascular events,and advance in target organ damage. Abnormal BPV may be softened or removed with suitabletime-dependent administration of anti-hypertensive agents, especially those acting on therenin–angiotensin system

Ocena czynników ryzyka chorób układu sercowo-naczyniowego u chorych poddawanych stacjonarnej wczesnej rehabilitacji kardiologicznej po ostrym incydencie wieńcowym

Introduction. Effective implementation of preventive strategies is a cornerstone element of cardiac rehabilitation after myocardial infarction (MI). We aimed to assess knowledge of cardiovascular risk factors among subjects after acute coronary syndrome treated with percutaneous intervention scheduled to in-hospital cardiac rehabilitation, and to evaluate the association between the level of their awareness and burden of cardiovascular risk. Material and methods. This cross sectional study included 205 consecutive subjects (153 males, 52 females, aged 62 ± 9 years). Data covering burden of arterial hypertension, overweight, dyslipidemia, diabetes, smoking habit, low level of physical activity, elderly, male gender and a history of familial heart disease were retrieved form medical records and anamnesis. Knowledge and awareness of modifiable and non-modifiable cardiovascular risk factors were assessed by a questionnaire. Results. The surveyed patients usually had 5 risk factors (mean 4.53 ± 1.43). The best awareness concerned their own body mass (98%) and blood pressure level (74%). The subjects had suboptimal knowledge regarding recommendations of secondary prevention (< 50% of correct answers). In 20 questions investigating knowledge about risk factors, the patients most frequently gave 11 correct answers (mean 54 ± 18%). There was no association between burden of specific risk factors and patients’ awareness of these factors, excluding the fact that diabetics knew their glucose level (odds ratio 2.9; 95% confidence interval 1.5–5.6, p < 0.01). There was no correlation between patients’ knowledge and the number of risk factors they had (r = –0.02, p = 0.2). Conclusions. Despite significant burden of cardiovascular risk, the level of awareness regarding this issue remains insufficient. Also, risk factor burden does not determine the patients’ knowledge. There is a need for education about secondary prevention to improve attitudes among patients after MI.Wstęp. Skuteczne wdrożenie zasad prewencji jest jednym z priorytetów kompleksowej rehabilitacji osób po zawale serca (MI). Celem pracy była ocena znajomości czynników ryzyka chorób układu sercowo-naczyniowego u chorych po ostrym incydencie wieńcowym leczonych przezskórną angioplastyką, poddawanych rehabilitacji kardiologicznej w warunkach stacjonarnych oraz ocena związku między ich znajomością a rozpowszechnieniem. Materiał i metody. Przekrojowym badaniem objęto 205 kolejnych chorych (153 mężczyzn i 52 kobiety w wieku 62 ± 9 lat). Informacje dotyczące obciążenia nadciśnieniem tętniczym, nadwagą, dyslipidemią, cukrzycą, paleniem tytoniu, małą aktywnością fizyczną, starszym wiekiem, płcią męską i dodatnim wywiadem rodzinnym uzyskano na podstawie dostępnej dokumentacji medycznej oraz wywiadu. Kwestionariuszowo oceniono wiedzę i znajomość modyfikowalnych i niemodyfikowalnych czynników ryzyka sercowo-naczyniowego. Wyniki. Badani najczęściej byli obciążeni 5 czynnikami ryzyka (średnio 4,53 ± 1,43). Najlepsza znajomość dotyczyła własnej masy ciała (98%) i ciśnienia tętniczego (74%). Pacjentów cechowała suboptymalna wiedza o rekomendacjach w zakresie prewencji wtórnej (< 50% prawidłowych odpowiedzi). W 20 pytaniach o znajomość poszczególnych czynników ryzyka pacjenci najczęściej wskazywali 11 poprawnych odpowiedzi (średnio 54 ± 18%). Nie odnotowano związku między obciążeniem poszczególnymi czynnikami ryzyka a ich znajomością oraz wiedzą na temat zasad prewencji, z wyjątkiem obecności cukrzycy, a znajomością glikemii (iloraz szans = 2,9; 95-proc. przedział ufności CI 1,5–5,6; p < 0,01). Nie stwierdzono korelacji między wiedzą badanych a sumarycznym obciążeniem czynnikami ryzyka (r = –0,02; p = 0,2). Wnioski. Mimo znaczącego obciążenia ryzykiem sercowo-naczyniowym, badanych cechuje niezadowalająca świadomość w tym temacie. Obecność czynników ryzyka nie determinuje wiedzy na ich temat. Konieczne są skuteczne interwencje edukacyjne dotyczące prewencji wtórnej, celem podniesienia postaw osób po MI.

Effect of fluid resuscitation with balanced solutions on platelets: In vitro simulation of 20% volume substitution

   Background: Fluid resuscitation in massive bleeding may cause coagulation disorders by dilution of platelets and clotting factors or by the impact on their function. The aim of this study was to investigate the effects of balanced crystalloid and colloid solutions on platelets in vitro using complex assessment of coagulation. Methods: The study group was comprised of 32 American Society of Anesthesiologists physical status class I male volunteers, aged 21–35 (29 ± 4) years, weighting 59–103 (81.2 ± 9.8) kg. Whole blood samples were diluted at a 4:1 ratio with the following fluids: balanced crystalloid (Plasmalyte®), 6% hydroxyethyl starch 130/0.4 (Volulyte®) and succinylated gelatin (Geloplasma®). Coagulation was as­sessed using standard morphology, rotational thromboelastometry and aggregometry. Results: Dilution with all fluids caused statistically significant drop in the number of platelets (p < 0.01) but the effect did not differ between solutions (p > 0.05 for all). Other platelet parameters, such as platelet distribution width, mean platelet volume and platelet-large cell ratio were not affected by the solutions. Hemodilution had no effect on platelet function (p = 0.1). Decreased platelet component of clot strength was found for all three fluids (p < 0.05), although the effect for colloids was more pronounced. Conclusions: The effect of balanced crystalloids and colloids on platelet aggregation was insignificant, even after 20% volume substitution with the resuscitation fluids.

Determinanty zapalenia mięśnia sercowego u młodych dorosłych — 3-letnie doświadczenia jednego ośrodka

Introduction. Myocarditis is a challenging diagnosis due to the heterogeneity of clinical presentations. This inflammatory myocardial disease should be diagnosed based on established clinical, laboratory and imaging criteria.Material and methods. We studied consecutive patients aged 18–40 years admitted to an emergency department (ED) with the diagnosis of an acute coronary syndrome (ACS) between January 01, 2011 and December 31, 2013. Demographic, clinical and laboratory data were analysed. The patients were diagnosed with myocarditis based on the history of a respiratory or gastrointestinal tract infection, clinical symptoms of reduced exercise tolerance, chest pain, arrhythmias or new onset symptoms of heart failure, with abnormal electrocardiographic and/or echocardiographic findings and elevated markers of myocardial necrosis. All subjects underwent coronary angiography to exclude or confirm an ACS.Results. Patients with myocarditis were younger (median age 30.5 years, interquartile range [IQR] 20.5–32) compared to ACS patients (median age 39 years, IQR 35–39.5; (p = 0.001). All young adults with myocarditis had a history of infection within 4 weeks and it was the strongest determinant of myocarditis (odds ratio [OR] 113.7, 95% confidence interval [CI] 5.64–2289.7; p < 0.001). Compared to ACS patients, those with myocarditis were more likely to report a history of fever (OR 17.22; 95% CI 0.9–330.5; p = 0.06) and have an elevated white blood cell count (median 9.95, IQR 8.3–11.95 vs. 8.2, IQR 6.4–10.32; p = 0.07), elevated high-sensitivity C-reactive protein level (OR 29.3; 95% CI 1.14–748.6; p = 0.04), higher left ventricular ejection fraction (median 60, IQR 60–65 vs. 55, IQR 50–55; p = 0.001),and elevated creatine kinase activity (OR 7.94; 95% CI 1.41–44.8; p = 0.02). Dyslipidaemia was less frequent in young adults with myocarditis (OR 0.03; 95% CI 0.003–0.3; p = 0.002).Conclusions. Infection-related parameters are key determinants of myocarditis in young adults with chest pain. These easily accessible clinical and laboratory parameters should guide further clinical decision-making in ED.Wstęp. Zapalenie mięśnia sercowego jest często wyzwaniem diagnostycznym ze względu na niejednoznaczny obrazkliniczny. Ta zapalna choroba mięśnia sercowego powinna być rozpoznawana na podstawie określonych kryteriów klinicznych, laboratoryjnych i wyników badań obrazowych.Materiał i metody. Do badania włączano kolejnych chorych w wieku 18–40 lat, kierowanych na szpitalny oddział ratunkowy z rozpoznaniem ostrego zespołu wieńcowego (ACS) w okresie od 1 stycznia 2011 roku do 31 grudnia 2013 roku. Obok szczegółowego wywiadu chorobowego u każdego pacjenta oznaczano laboratoryjne markery uszkodzenia mięśnia sercowego i wykładniki stanu zapalnego oraz wykonywano elektrokardiografię (EKG) i echokardiografię (UKG). U wszystkich chorych wykonano angiografię naczyń wieńcowych. Rozpoznania zapalenia mięśnia sercowego dokonywano z wykluczenia, na podstawie charakterystycznego wywiadu, objawów klinicznych, zmian w obrazach EKG i UKG oraz wyników badań laboratoryjnych, przy prawidłowym wyniku koronarografii.Wyniki. Osoby z zapalenia mięśnia sercowego były znamiennie statystycznie młodsze (mediana wieku [Me] = 30,5; zakres międzykwartylowy [IQR] 20,5–32) niż chorzy z ACS (Me = 39; IQR 35–39,5) (p = 0,001). Wszyscy młodzi dorośli z rozpoznanym zapalenia mięśnia sercowego w ostatnich 4 tygodniach przebyli infekcję, najczęściej dróg oddechowych. Był to najsilniejszy determinant zapalenia mięśnia sercowego (iloraz czans [OR] = 113,7; 95-proc. przedział ufności [CI] 5,64–2289,7; p < 0,001). Czas trwania infekcji wynosił 4 (IQR 3,5–7) dni. Osoby z zapaleniem mięśnia sercowego cechowały się ponadto częstszym występowaniem gorączki w wywiadzie (OR = 17,22; 95% CI 0,9–330,5; p = 0,06), większą liczbą leukocytów w morfologii krwi obwodowej (Me = 9,95; IQR 8,3–11,95 v. Me = 8,2; IQR 6,4–10,32; p = 0,07) oraz podwyższonym stężeniem wysokoczułego białka C-reaktywnego (OR = 29,3; 95% CI 1,14–748,6; p = 0,04). Osoby z ACS cechowała znamiennie gorsza frakcja wyrzutowa lewej komory (Me = 60; IQR 60–65 v. Me = 55; IQR 50–55; p = 0,001), jednak nie przekładało się to na różnicę między grupami pod względem odsetka osób z obniżoną poniżej 50% funkcją (OR = 0,34; 95% CI 0,03–4,2; p = 0,8). Obciążenie klasycznymi czynnikami ryzyka sercowo-naczyniowego nie różniło się między grupami, z wyjątkiem dyslipidemii, która u osób z zapaleniem mięśnia sercowego występowała znacznie rzadziej (OR = 0,03; 95% CI 0,003–0,3; p = 0,002).Wnioski. U młodych osób dorosłych czynnikami różnicującymi przyczynę stenokardii są infekcja w wywiadzie, podwyższone parametry stanu zapalnego oraz obecność dyslipidemii

Utstein-style reporting of out-of-hospital cardiac arrest in the Bielsko-Biała county

Introduction. Out-of-hospital cardiac arrest (OHCA) is one of the most severe medical emergencies, with significantly high both pre- and in-hospital mortality rates. The aim of the study was to assess the quality of reporting OHCA data by the Emergency Medical Service teams (EMS) in the Bielsko-Biała county, using standard ambulance dispatch cards. Material and methods. The study included adult inhabitants of Bielsko-Biała county who suffered from OHCA in 2013. Data were retrieved from standardised PRM forms, and compared to the Utstein style template. The study group comprised 272 patients, 190 (70%) males and 82 (30%) females, with a median age of 71 years (IQR 60–80). The pre-hospital mortality rate was 76.5% (75.3% in men and 79.3% in women). Results. The potential cause of OHCA was least known, with only 22% of forms including any information concerning this issue. Suboptimal reporting on the data enabling patient identification was noted in 12% cases. There was no association between reporting style and time and place of the OHCA. Conclusions. The overall quality of reporting of OHCA by PMR in Bielsko-Biała was good. The greatest concern was inability to identify the potential cause of the event, which can significantly influence application of adequate treatment

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

Background: The purpose of this review was to summarize the up-to-date knowledge on clinical presentation and management of neurocardiogenic injury and to deliver the evidence of common pathophysiology of this broad spectrum of disorders.Methods: Medline and EmBase databases were searched to obtain original research articles and review papers using the following key words: neurocardiogenic injury, stress cardiomyopathy,tako-tsubo, subarachnoid hemorrhage, ECG abnormalities, catecholamine toxicity, neuropulmonary edema.Results: Various forms of cerebral pathology, most importantly subarachnoid hemorrhage (SAH), are accompanied by transient cardiac dysfunction with ST-segment elevation and QT interval prolongation and T wave inversion with simultaneous release of cardiac troponin. In the past 20 years a great deal of data emerged concerning stress cardiomyopathy (‘tako-tsubo’) presenting as a rare transient apical ballooning syndrome following stressful life events with symptoms and signs resembling acute myocardial infarction (AMI), yet without significant coronary artery stenosis. Both forms of cardiac dysfunction are mediated by catecholamine toxicity, triggered by physical and psychological distress, leading to a specific type of neurogenic myocardial stunning reflected by histopathological image of contraction band necrosis.Conclusions: Neurocardiogenic injury should be carefully differentiated from AMI. Cardiac dysfunction in SAH heralds increased mortality. The criteria for the diagnosis of stress cardiomyopathy should be revised to comprise the diversity of its clinical symptomatology and to include cardiac dysfunction accompanying cerebral pathology.