The BE-ALIVE score: assessing 30-day mortality risk in patients presenting with acute coronary syndromes

AIM: To create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) at their moment of admission. METHODS AND RESULTS: 2407 consecutive patients presenting to Harefield Hospital with measured arterial blood gases, from January 2011 to December 2020, were studied to build the training set. 30-day mortality in this group was 17.2%. A scoring algorithm that was built using binary logistic regression of variables available on admission was then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors:Base Excess (1 point for <-2 mmol/L), Age (<65 years: 0 points, 65-74: 1 point, 75-84: 2 points, ≥85: 3 points), Lactate (<2 mmol/L: 0 points, 2-4.9: 1 point, 5-9.9: 3 points, ≥10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: -1 point, moderately impaired: 1 point, severely impaired: 3 points) and External/out of hospital cardiac arrest 2 points).The scoring system was validated using a testing set of 515 patients presenting to Harefield Hospital in 2021. The validation metrics were excellent with a c-statistic of 0.9, Brier's score 0.06 vs a naïve classifier of 0.15, Spiegelhalter's z-statistic probability of 0.267 and a calibration slope of 1.08. CONCLUSION: The BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS. Appreciating this mortality risk can allow prompt involvement of appropriate care such as the shock team

Ηλεκτρομυϊκός ερεθισμός σε ολόκληρο το σώμα σε ασθενή πληθυσμό: Μια συστηματική ανασκόπηση

Περίληψη Εισαγωγή: Η θεραπεία του ηλεκτρομυϊκού ερεθισμού (Electromyostimulation – EMS) χρησιμοποιείται κατά κόρον από τους επαγγελματίες της επιστήμης της φυσικοθεραπείας ως μέθοδος αποκατάστασης και άσκησης των σκελετικών μυών του σώματος. Χρησιμοποιείται τόσο για υγιή, όσο και ασθενή άτομα, προκαλώντας αύξηση της μυϊκής μάζας, μείωση του ποσοστού λίπους σώματος και βελτίωση της κινησιολογίας. Θεωρείται μια ασφαλής και οικονομική θεραπεία, η οποία μπορεί να είναι πολύ αποτελεσματική. Σκοπός: Σκοπός της συγκεκριμένης συστηματικής ανασκόπησης είναι η συγκέντρωση της διαθέσιμης βιβλιογραφίας, όπου αφορά την εφαρμογή του ηλεκτρομυϊκού ερεθισμού σε ολόκληρο το σώμα σε ασθενείς, ώστε να αξιολογηθεί ποιοτικά η αποτελεσματικότητα της μεθόδου. Μεθοδολογία: Για την μελέτη χρησιμοποιήθηκαν τρεις βάσεις δεδομένων, το Pubmed, το Scopus και το Pedro, ώστε να αναζητηθούν τα σχετικά άρθρα. Μετέπειτα, τα άρθρα αυτά αξιολογήθηκαν βάσει της κλίμακας Pedro και συντέθηκε ο πίνακας των αποτελεσμάτων βάσει της μεθοδολογίας PICOs. Αποτελέσματα: Συνολικά ανιχνεύτηκαν 18 άρθρα, τα οποία πληρούσαν τα κριτήρια εισόδου και αποκλεισμού. Τα περισσότερα άρθρα από αυτά ήταν άρθρα, που συγκεντρώνουν υψηλή βαθμολογία βάσει της κλίμακας Pedro, κατά συνέπεια είναι υψηλού επιπέδου μεθοδολογικού σχεδιασμού. Στις παρεμβάσεις, στις οποίες ανέτρεξε ο ερευνητής, βρέθηκε ότι η εφαρμογή του ηλεκτρομυϊκού ερεθισμού επιφέρει ένα πλήθος ευεργετικών επιδράσεων σε άτομα με χρόνιες παθήσεις. Η αύξηση του μυϊκού ιστού, η μείωση του ποσοστού λίπους σώματος, η αύξηση δύναμης των άκρων, η βελτίωση της εικόνας της νόσου είναι ορισμένες από τις θετικές επιδράσεις της ηλεκτρομυϊκής διέγερσης. Συζήτηση:Η θεραπεία του ηλεκτρομυϊκού ερεθισμού είναι μια χρήσιμη και αποτελεσματική τεχνική, η οποία μπορεί να χρησιμοποιηθεί προς όφελος αρκετών ασθενειών και ιατρικών παθήσεων, όπως είναι ο χρόνιος τραυματισμός της σπονδυλικής στήλης, η σαρκοπενική παχυσαρκία, η σαρκοπενία, η χρόνια αποφρακτική πνευμονοπάθεια, οι κακοήθεις νεοπλασίες και η μετ-εμμηνόπαυση. Λέξεις κλειδιά: Ηλεκτρομυϊκός ερεθισμός, ηλεκτρομυϊκή διέγερση, ΗΝΜΕ, ολόκληρο το σώμα, συστηματική ανασκόπησηAbstract Introduction: Electromyostimulation (EMS) treatment has been used for the most as a rehabilitation method of musculoskeletal disorders by physiotherapists. It is used not only for healthy, but also sick individuals too. Seemingly, electromyostimulation method is used not only to healthy individuals but also patients. Some of the benefits of the treatment are muscle mass increase, total body fat decrease and overall improvement of movements. EMS has been studied through years either alone as method, or in comparison with others as well. Finally, EMS is considered to be a safe, low-cost and effective rehabilitation method. Purpose: The main purpose of this systematic review is to gather up all the available information about whole body EMS on people who have some specific chronic illness or condition, so that investigators could be able to evaluate the effectiveness of whole-body EMS. Methods &amp; tools: There were used mainly three databases for the research, Pubmed, Scopus and Pedro. Afterwards, all the relevant articles had been evaluated by Pedro scale and finally there has been created a results-table based on PICOs methodology. Results: Overall, 18 articles have been identified as relevant throughout the research. All of them were meet the inclusion and exclusion criteria. Most of the selected articles were high scored (by Pedro scale evaluation), which means that they are high quality on their methodology. Muscle mass increase, body fat decrease, improvement of limb strength and improvement of patients clinical profile are some of the benefits of the treatment. Based on the included interventions it was found that, WB-EMS has a great range of benefits on people with chronic conditions or diseases. Conclusion: WB-EMS therapy is a quite useful and effective technique, which could be used to improve many chronic diseases and medical issues, such as chronic spinal cord injury, sarcopenic obesity, sarcopenia, chronic pulmonary disease, malignancies and post-menopausal. Key words: Electromyostimulation, electrical stimuli, EMS, whole body, systematic revie

Lack of association between glucocorticoid use and presence of the metabolic syndrome in patients with rheumatoid arthritis: a cross-sectional study

Introduction - Rheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality, attributed to both traditional and novel cardiovascular risk factors. The metabolic syndrome, a cluster of classical cardiovascular risk factors, including hypertension, obesity, glucose intolerance, and dyslipidaemia, is highly prevalent in RA. Reports suggest that long-term glucocorticoid (GC) use may exacerbate individual cardiovascular risk factors, but there have been no studies in RA to assess whether it associates with the metabolic syndrome. We examined whether GC exposure associates with the presence of metabolic syndrome in patients with RA. Methods - RA patients (n = 398) with detailed clinical and laboratory assessments were categorised into three groups according to GC exposure: no/limited (<3 months) exposure (NE), low-dose (<7.5 mg/day) long-term exposure (LE), and medium-dose (greater than or equal to 7.5 mg to 30 mg/day) long-term exposure (ME). The metabolic syndrome was defined using the National Cholesterol Education Programme III guidelines. The association of GC exposure with the metabolic syndrome was evaluated using binary logistic regression. Results - The metabolic syndrome was present in 40.1% of this population and its prevalence did not differ significantly between the GC exposure groups (NE 37.9% versus LE 40.7% versus ME 50%, P = 0.241). Binary logistic regression did not demonstrate any increased odds for the metabolic syndrome when comparing ME with LE (odds ratio = 1.64, 95% confidence interval 0.92 to 2.92, P = 0.094) and remained non significant after adjusting for multiple potential confounders. Conclusions - Long-term GC exposure does not appear to associate with a higher prevalence of the metabolic syndrome in patients with RA. The components of the metabolic syndrome may already be extensively modified by other processes in RA (including chronic inflammation and treatments other than GCs), leaving little scope for additive effects of GCs

Coronary heart disease in Indian Asians.

The Indian Asian population accounts for a fifth of all global deaths from coronary heart disease (CHD). CHD deaths on the Indian subcontinent have doubled since 1990, and are predicted to rise a further 50% by 2030. Reasons underlying the increased CHD mortality among Indian Asians remain unknown. Although conventional cardiovascular risk factors contribute to CHD in Indian Asians as in other populations, these do not account for their increased risk. Type-2 diabetes, insulin resistance and related metabolic disturbances are more prevalent amongst Indian Asians than Europeans, and have been proposed as major determinants of higher CHD risk among Indian Asians. However, this view is not supported by prospective data. Genome-wide association studies have not identified differences in allele frequencies or effect sizes in known loci to explain the increased CHD risk in Indian Asians. Limited knowledge of mechanisms underlying higher CHD risk amongst Indian Asians presents a major obstacle to reducing the burden of CHD in this population. Systems biology approaches such as genomics, epigenomics, metabolomics and transcriptomics, provide a non-biased approach for discovery of novel biomarkers and disease pathways underlying CHD. Incorporation of these omic approaches in prospective Indian Asian cohorts such as the London Life Sciences Population Study (LOLIPOP) provide an exciting opportunity for the identification of new risk factors underlying CHD in this high risk population

Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning

Aims Revascularization strategy for patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease varies according to the patient’s cardiogenic shock status, but assessing shock acutely can be difficult. This article examines the link between cardiogenic shock defined solely by a lactate of ≥2 mmol/L and mortality from complete vs. culprit-only revascularization in this cohort. Methods and results Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate ≥2 mmol/L between 2011 and 2021 were included. The primary endpoint was mortality at 30 days by revascularization strategy for shocked patients. Secondary endpoints were mortality at 1 year and over a median follow-up of 30 months. Four hundred and eight patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularization (CR) was associated with higher mortality at 30 days [odds ratio (OR) 2.1 (1.02–4.2), P = 0.043], 1 year [OR 2.4 (1.2–4.9), P = 0.01], and over 30 months follow-up [hazard ratio (HR) 2.2 (1.4–3.4), P < 0.001] compared with culprit lesion-only percutaneous coronary intervention (CLOP). Mortality was again higher in the CR group after propensity matching (P = 0.018) and inverse probability treatment weighting [HR 2.0 (1.3–3.0), P = 0.001]. Furthermore, explainable machine learning demonstrated that CR was behind only blood gas parameters and creatinine levels in importance for predicting 30-day mortality. Conclusion In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of ≥2 mmol/L, CR is associated with higher mortality than CLOP.British Heart Foundation (FS/19/73/34690 to I.C.)

Unanticipated Pseudocoarctation Highlights the Importance of Visualizing Aortic Arch Anatomy Before Transfemoral Transcatheter Aortic Valve Implantation

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