Reaktívoxigén-származékok szerepe a szívműködés szabályozásában

Absztrakt A reaktívoxigén-származékok fokozott termelődése fontos szerepet játszik a szívelégtelenség patogenezisében. Azonban mint jelátviteli molekula, a szív fiziológiás folyamatainak összehangolásában is részt vesz. Jelen közleményben a szerzők összefoglalják, hogy a reaktívoxigén-származékok endogén produkciója milyen szerepet tölt be a szív pumpafunkciójának szabályozásában fiziológiás viszonyok között. Orv. Hetil., 2015, 156(47), 1912–1915

Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study

BACKGROUND During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics

Positive inotropic effect of apelin mediated through ERK1/2. A.

<p>Effect of apelin (Apelin-16 12 nmol/L) and U0126 (5 μmol/L) on developed tension in isolated perfused, paced rat hearts. After a control period vehicle or drugs were infused for 15 minutes. Results are expressed as a percent change vs. baseline values. Data are mean ± SEM (n = 4). <b>B.</b> Western blot analysis of ERK 1/2 phosphorylation in left ventricles of hearts treated with vehicle, apelin and U0126, or their combination for 15 minutes. Results in the bar graph are expressed as the ratio of phospho-ERK1/2 (p-ERK 1/2) and total (tot) ERK1/2 (n = 5). <b>C.</b> ERK1/2 phosphorylation in a representative blot of left ventricular proteins from hearts treated with vehicle, apelin and U126, or their combination for 15 minutes. *P<0.5; **P<0.01; ***P<0.001 vs. vehicle, †P<0.5; †††P<0.001 vs. apelin by repeated measures ANOVA and Bonferroni post-hoc test.</p

Positive inotropic effect of apelin mediated through RLC. A.

<p>Effect of apelin (Apelin-16 2 nmol/L) and ML-7 (1 μmol/L) on developed tension in isolated perfused, paced rat hearts. After a control period vehicle or drugs were infused for 20 minutes. Results are expressed as a percent change vs. baseline values. Data are mean ± SEM (n = 5). ***p<0.001 vs. vehicle control, ††p<0.01 vs. apelin by repeated measures ANOVA and Bonferroni post-hoc test. <b>B.</b> Representative Western blot detection of RLC phosphorylation in left ventricular proteins of apelin treated and control animals using non-denaturating urea gel electrophoresis. RLC: non-phosphorylated RLC; 1P-RLC: 1x phosphorylated RLC; 2P-RLC: 2x phosphorylated RLC.</p

Apelin and MAPK signaling. A.

<p>Western blot analysis of time-dependent ERK1/2 phosphorylation in left ventricles. Results in the bar graph are expressed as the ratio of phospho-ERK1/2 (p-ERK 1/2) and total (tot) ERK1/2 in percent of values in vehicle-treated control animals (n = 5–6). <b>B.</b> ERK1/2 phosphorylation in a representative blot of left ventricular proteins from hearts treated with apelin or vehicle for 10 minutes. <b>C.</b> Western blot analysis of time-dependent p38 phosphorylation in left ventricles. Results in the bar graph are expressed as the ratio of phospho-p38 (p-p38) and total (tot) p38 in percent of values in vehicle-treated control animals (n = 4–5). <b>D.</b> p38 phosphorylation in a representative blot of left ventricular proteins from hearts treated with apelin or vehicle for 10 minutes. <b>+</b>P<0.05 vs. vehicle, ‡ P<0.01 vs. vehicle by unpaired Student’s t test.</p

Relation of apelin-induced ERK1/2 phosphorylation to PKCs. A.

<p>Western blot analysis of ERK 1/2 phosphorylation in left ventricles of hearts treated with vehicle, apelin and Bis, or their combination for 20 minutes. Results in the bar graph are expressed as the ratio of phospho-ERK1/2 (p-ERK 1/2) and total (tot) ERK1/2 (n = 5). *p<0.05 vs. vehicle by one-way ANOVA followed by a Bonferroni post hoc test. <b>B.</b> ERK1/2 phosphorylation in a representative blot of left ventricular proteins from hearts treated with vehicle, apelin and Bis, or their combination for 20 minutes.</p

Positive inotropic effect of apelin mediated through PKC. A.

<p>Effect of apelin (Apelin-16 2 nmol/L) and Bis (90 nmol/L) on developed tension in isolated perfused, paced rat hearts. After a control period vehicle or drugs were infused for 20 minutes. Results are expressed as a percent change vs. baseline values. Data are mean ± SEM (n = 5). ***p<0.001 vs. vehicle control, †p<0.05 vs. apelin by repeated measures ANOVA and Bonferroni post-hoc test. <b>B.</b> Representative Western blot detection of translocation of PKCε and α isoforms from the soluble (S) to the particulate (P) fraction of left ventricular proteins in apelin treated and control animals.</p

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics

The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study

Background: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. Objective: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Methodology: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Main outcome measures: Patient’s first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Results: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania’s apps considered social needs. Conclusions: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases