Considering Bias Through the Mirror/ Window of Art and Literature

Although narrative medicine has become an established tool in teaching reflection, empathy, among other critical skills in medical education, its use in promoting equity, diversity, and inclusion has not yet been thoroughly explored. Educators in narrative medicine in a medical school setting reflect upon creating and implementing a curriculum that highlights voices of BIPOC, LGBTQ+, and persons living with disability. Narrative tools to promote self-reflection and examination of personal biases are explored and considered as a method of fulfilling our collective call to action for increased equity in medical education

Evaluation of exercise capacity with cardiopulmonary exercise test and B-type natriuretic peptide in adults with congenital heart disease

Background: Adult patients with congenital heart disease (CHD) usually find their exercise capacity satisfactory. However, objective evaluation is important for diagnostic and prognostic purposes. The aim of this study was to evaluate exercise capacity using cardiopulmonary exercise tests and measurement of serum B-type natriuretic peptide (BNP) levels in adult patients with CHDs, both in the entire study cohort and in subjects with individual types of cardiac lesions, as well as to verify the relation between BNP level and cardiac performance. Methods: The study group included 265 patients (136 males; mean age 34.4 ± 11.6 years) 173 of whom were operated on at the mean age of 9.2 ± 7.3 years. They represented the following types of CHD: 72 patients - surgically corrected coarctation of the aorta, 62 - surgically corrected tetralogy of Fallot, 28 - Ebstein anomaly, 26 - patent atrial septal defect, 24 - Eisenmenger syndrome, 20 - uncorrected or palliated complex cyanotic lesions, 11 - corrected transposition of the great arteries (TGA), 14 - TGA after Senning operation, and 8 - common ventricle after Fontana operation. The control group consisted of 39 healthy individuals (17 males) with a mean age of 35.8 ± 9.3 years. Results: According to NYHA classification, 207 patients were recognized as representing class I symptoms, 47 subjects class II, and 11 class III. Cardiopulmonary exercise revealed significantly reduced exercise capacity in adults with CHD in general, compared to control subjects: maximal oxygen uptake (VO2max) was 23.3 ± 6.9 vs. 33.6 ± 7.2 mL/kg/min, respectively (p = 0.00001); maximum heart rate at peak exercise (HRmax) -161.1 ± 33.2 vs. 179.6 ± 12.3 bpm (p = 0.00001); respiratory workload (VE/VCO2slope) - 35.7 ± 9.7 vs. 26.3 ± 3.1 (p = 0.00001); and forced vital capacity (FVC) - 3.8 ± 1.1 vs. 4.6 ± 0.7 L (p = = 0.00003). Various degrees of peak VO2max reduction were observed across the spectrum of CHD. Patients after repair of aortic coarctation demonstrated the highest VO2max (26.8 ± 6.6 mL/kg/min), and the lowest was demonstrated by patients with Eisenmenger syndrome (12.8 ± 4.8; ANOVA p = 0.00001). Serum BNP levels in the study group were higher than in the controls: 55.4 ± 67.5 vs. 13.9 ± 13.7 pg/mL, respectively (p = 0.00001). Various degrees of BNP level increase were found across the spectrum of CHD. Patients after repair of aortic coarctation demonstrated the lowest BNP level (24.8 pg/mL), and the highest level was found in patients with cyanotic defects (120.7 pg/mL; ANOVA p = 0.00001). BNP levels across the NYHA classes were as follows: I - 35.7 pg/mL, II - 94.1 pg/mL, and III - 225.6 pg/mL. BNP levels showed negative correlation with VO2max (r = –0.525, p = 0.0001), FVC (r = = –0.349, p = 0.00001), FEV1 (r = –0.335, p= 0.00001), and positive correlation with VE/VCO2slope (r = 0.447, p = 0.00001). Conclusions: The exercise capacity of patients with CHD is, in general, compromised, most strikingly in patients suffering from pulmonary hypertension and cyanosis. Serum BNP levels in these subjects are increased and correlate well with exercise capacity. BNP level is higher in patients with cyanotic CHDs

Magnesium 2000 postmarket evaluation : Guideline adherence and intraprocedural performance of a sirolimus-eluting resorbable magnesium scaffold

Background The Magmaris bioresorbable magnesium scaffold was successfully tested in in-vitro and in clinical premarket studies. Subsequently the Magmaris postmarket program aimed to review intraprocedural data of at least 2000 patients to assess user preferences, guideline adherence and intraprocedural performance in clinical routine. Methods This international multicentre survey encompasses data from 356 hospitals across 45 countries. As part of the certification for Magmaris implantation, each hospital had to complete consecutive post-market evaluation forms of their first 10 commercial Magmaris patients. Results From June 2016 to May 2018, data on 2018 implantations were collected. Main reasons for selecting Magmaris was patients' life expectancy (67%, n = 1359) and low or not calcified lesions, (67%, n = 1357). Magmaris was successfully deployed in 99% of cases (n = 1995), predilatation was performed in 95% (n = 1922) and post-dilatation in 87% (n = 1756). Physicians rated the overall performance and the pushability as good or very good in 96% of cases (n = 1799). Guide wire friction, trackability, and conformability were rated as good or very good in 94% of cases, and crossability in 93%. The majority of patients were scheduled to receive dual antiplatelet therapy for up to 12 months. Conclusion Generally, implantation guidelines were adhered to and theoretical advantages of the metal scaffold observed in in-vitro tests have translated into practice with good intraprocedural performance outcomes, confirming the controlled roll-out of this novel technology into clinical practice. (C) 2019 The Authors. Published by Elsevier Inc.Peer reviewe

Does the operator's sex matter? An analysis based on the national interventional cardiology registry

Background: A small number of female cardiologists work in the field of interventional cardiology. Such disparity is observed in most European countries. Aims: We present the first national report on the practice patterns and outcomes regarding percutaneous coronary interventions (PCIs) performed by female operators (FOs) in Poland. Methods: Data were collected from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]) between January 2014 and December 2017. Results: A total of 31 FOs (4.1%) performed 12 935 PCIs (2.8%). The median (interquartile range [IQR]) number of PCIs performed by FOs per year was 75 (43–154), whereas that by male operators was 139 (67–216; P < 0.01). Patients handled by FOs were characterized by a lower prevalence of cardiovascular risk factors and previous coronary artery interventions. Acute coronary syndrome was the main indication for treatment (74.66%). Compared with male operators, FOs handled significantly more patients with single‑vessel disease (87.02% vs 84.72%; P < 0.001). They used smaller contrast doses during PCIs (median [IQR], 170.36 [77.54] cm3 vs 173.48 [77.54] cm3; P < 0.001) yet higher doses of radiation exposure (median [IQR], 843 [472–1409] mGy vs 815 [458–1390] mGy; P = 0.01). There was no difference in clinical outcomes (a composite of all‑cause death, bleeding at the puncture site, or coronary artery perforation) associated with the operator’s sex. Conclusions: Women represent a minority of operators in interventional cardiology and are responsible for a low percentage of PCIs. Nonetheless, the practice patterns and outcomes of PCIs performed by FOs are similar to those of male operators

Comparison of Hepatic and Nephric Total Mercury Concentrations Between Feral and Ranch American Mink (Neovison vison) from Northwestern Poland

For many years the American mink (Neovison vison) has been used in North America (where it originates from) as a sensitive indirect bioindicator in assessing the degree of mercury (Hg) contamination in terrestrial ecosystems. The aim of this paper was the determination of total concentrations of Hg in the liver and kidneys of feral and ranch mink from the Warta Mouth National Park (WMNP) and from farms located in northwestern Poland, for comparison with similar data on American mink from North America. In road-killed feral mink from the WMNP, the mean concentrations were 11.8 and 14.1 mg/kg dry weight in the liver and kidney, respectively. Mean Hg concentrations in feral mink were from 240 to 90 times higher in these two respective tissues than in ranch mink. The feral mink from northwestern Poland had concentrations of hepatic and nephric Hg similar to the highest concentrations that have been recorded over the past several decades in wild American mink from certain areas of Canada and the USA

Trace metals and micronutrients in bone tissues of the red fox Vulpes vulpes (L., 1758)

In this study we determined the levels of trace elements (zinc, copper, lead, cadmium and mercury) in three layers of bones of the hip joint (cartilage, compact bone and spongy bone) of 30 red foxes (Vulpes vulpes) from north-western Poland. Concentrations of Cu, Zn, Pb and Cd were determined by atomic absorption spectrophotometry (ICP-AES) in inductively coupled argon plasma using a Perkin-Elmer Optima 2000 DV. Determination of Hg concentration was performed by atomic absorption spectroscopy. In cartilage, compact bone and spongy bone samples from the red fox, median concentrations of the metals studied could be arranged in the following descending series: Zn > Cu > Pb > Cd > Hg, the values ranging from 142 to 0.002 mg/kg dw. There was a significant difference in Cu concentrations, among all the materials analyzed, with much more Cu found in spongy bone than in compact bone. Significant differences were also noted in the case of Hg concentrations in cartilage with compact bone and the spongy bone, and between concentrations of this metal in compact bone and spongy bone. In males, the concentration of Hg in spongy bone was greater than in females. Younger foxes had a higher concentration of this metal in cartilage than adults. The strongest synergistic relationships were observed in spongy bone between the Zn and Cu, Zn and Cd, as well as between Cu and Cd. Statistically significant antagonistic relationships were detected between zinc and lead in compact bone. In addition to monitoring studies conducted on the abiotic environment, an urgent need exists for long-term monitoring of concentrations of heavy metals with long-term effects on living organisms. An important addition is provided by biomonitoring studies on domesticated and free-living mammals, including Canidae

Pets as Sentinels of Human Exposure to Neurotoxic Metals

The idea that animals may be used as sentinels of environmental hazards pending over humans and the associated public health implications is not a new one. Nowadays pets are being used as bioindicators for the effects of environmental contaminants in human populations. This is of paramount importance due to the large increase in the worldwide distribution of synthetic chemicals, particularly in the built environment. Companion animals share the habitat with humans being simultaneously exposed to and suffering the same disease spectrum as their masters. Moreover, their shorter latency periods (due to briefer lifespans) enable them to act as early warning systems, allowing timely public health interventions. The rise on ethical constraints on the use of animals and, consequently, on the sampling they can be subjected to has led to the preferential use of noninvasive matrices, and in this case we are looking into hair. This chapter focuses in three non-essential metals: mercury, lead, and cadmium, due to their ubiquitous presence in the built environment and their ability of affecting the mammal nervous system. There is a fairly short amount of studies reporting the concentrations of these metals in pets’ hair, particularly for cats. These studies are characterized, and the metal concentrations corresponding to different parameters (e.g., age, sex, diet, rearing) are described in order to provide the reader with a general vision on the use of this noninvasive matrix on the studies conducted since the last two decades of the twentieth century.publishe