Prognostic importance of acute heart failure persistence in patients with ST-elevation myocardial infarction

Introduction: Acute heart failure (AHF) is one of the most frequent complication of acute myocardial infarction (AMI). It is not only associated with a several-fold increase of in-hospital mortality but also, worsens the long-term survival in comparison to those without AHF. The AHF is observed to be more in AMI patients whose in-hospital stay is more than 3 days. The clinical implications and prognostic accuracy of the AHF term in the setting of AMI are yet unknown. Methods: We observed 1,104 consecutive cardiac care patients, who were admitted with ST-elevation AMI (STEMI). They were divided into groups according to the AHF presence {AHF(+) n=334 and AHF(-) n=764}. Among 334 AHF(+) patients: 252 patients were found to have a transient AHFt(+), whereas 82 of AHF(+) patients had persistent AHFp(+) during in-hospital period.  Patients' baseline characteristics, blood analysis, left ventricle (LV) and renal function data were assessed and analyzed on the admission day and 10th day post-admission. The follow-up was conducted on the 30th day and after 2 years. Results. STEMI patients accompanied by AHF(+) were older, presented mostly with anterior AMI (p<0.01), had lower LV ejection fraction (EF) (p<0.01) and a higher heart rate (p<0.05). Their rates of comorbidities and of in-hospital complications such as recurrent angina, reinfarction, LV aneurism were higher in comparision to AHF(-) patients. AHFp(+) patients had the shortest time from symptoms onset before thrombolysis in comparision to AHFt(+) and AHF(-) groups. Partial recovery of cardiac function according to Left ventricular ejection fraction (LVEF) and end-systolic volume index, occurred mainly in AHF(-) and AHFt(+) patients on the 10th day post-admission, but not in AHFp(+). STEMI patients with AHFp(+) demonstrated a larger infarct size, higher C-reactive protein and VGEF level, fasting glucose and heart rate on admission, higher erythrocyte sedimentation rate, absence of heart rate normalization on the 10th day post-admission. All of these markers were the signs of severe myocardial damage and inflammation, which can reflect worse recovery in AHF patients despite optimal management. Patients with AHF(+) had renal dysfunction on admission while its creatinine clearance (CrCl) decreased during the in-hospital period which is the reflection of a poor prognosis. Сardiovascular mortality and non-fatal MI were significantly higher in the AHFp(+) group as compared to the AHFt(+) and the AHF(–) groups during the 30 days and 2 years of follow-up. Conclusion: The AHF is a frequent STEMI complication. AHF lasting >3 days had worse short- and long-term prognosis. Therefore, an aggressive strategy should be recommended particularly in patients who have clinical signs and symptoms of persistent AHF

Probiotics for Diarrhea in Children

Diarrhea remains the second leading cause of death in children below 5 years of age; in addition it is also the reason for a considerable morbidity in children of all ages throughout the globe. Apart from oral rehydration solution, continued feeding, oral zinc and antibiotics for diarrhea of bacterial etiology, there have been no other proven measures for diarrheal illnesses in children. Probiotics are non-pathogenic live microorganisms. When ingested, probiotics can survive passage through the stomach and small bowel. Probiotics are supposed to have preventive as well as curative effects on several types of diarrhea of different etiologies

Eating behaviors of American adults during the COVID-19 pandemic

The objective was to assess the impact of the COVID-19 pandemic on eating behaviors of a cross section of the US adult population. Participants (N=844) completed a survey via Amazon Mechanical Turk which evaluated frequency of consumption of five food categories - mixed dishes, salty, sweet, creamy foods and beverages during perceived stress. Physical, emotional and psychological self-care and demographics were also collected. Males eating behaviors especially mixed dishes, sweet foods, and creamy foods decreased when stressed. However, in females there was an increase in the consumption of sweet and creamy foods. When compared to their counterpart, there was a reduction in food choices among minorities and Hispanics. Participants with higher BMI had increased eating behaviors of mixed dishes, salty, and sweet foods. The physical self-care scale revealed there was limited consumption of sweet foods but the psychological self-care demonstrated that there was an increase in creamy food intak

Influence of Varying Doses and Duration of Dietary Nitrates from Beetroot Juice on Sprint Performance in U.S. Army ROTC Cadets: A pilot study

Objective: Assess the effects of varying levels and duration of dietary nitrate supplementationfrom beetroot juice (BR) on sprint performance in army ROTC cadets. Methods: Army Reserve Officer Training Corps (ROTC) cadets were randomly assigned to oneof three treatment groups: control (CON); low beetroot juice dose (BR1); and high BR juice –BR2. For 0, 6 and 15 days nitrate consumption from BR groups were as follows: CON receivedone 16.9 oz. bottle of apple juice (0 mg NO 3 -); BR1 received one can of BR juice (300 mg, 4.84mmol NO 3 -), and BR2 received 2 cans (16.8 oz.) BR (600 mg, 9.68 mmol NO 3 -). One week priorto the study, each cadet completed body composition measurements, predicted aerobic capacitymeasurements, and nutritional analysis via two 24-hour dietary recalls. Differences in primarymeasures (distance covered in the Yo-Yo IR1) were analyzed with two-way repeated measuresANOVA tests both between groups (CON, BR1, BR2) and within groups (0, 6, and day 15).Descriptive statistics and frequency counts were run on all remaining variables with a one-wayANOVA or t-test, including maximal heart rate during the YoYo IR1, dietary compliance, dailyblood pressure, juice compliance, and conditioning work-outs Results: A dose-related enhancement with BR was observed; the data trended towardssignificance even in this small sample. A t-test revealed that there was a significant difference insprint performance by males and females overall at days 0, 6, 15 (p = 0.025, p = 0.005, p =0.004, respectively). Conclusion: A single (300 mg, 4.84 mmol NO 3 ) or double (600 mg, 9.68 mmol NO 3 -) daily doseconsumption of BR appears to benefit ROTC cadets in athletic performance. Daily consumptionof BR benefitted ROTC males more than females. Results suggest BR supplementation could beadvantageous for sprint performance when administered for a longer duration (> 15 days)

Acute intermittent porphyria with posterior reversible encephalopathy syndrome in pregnancy: a case report

Background: The porphyrias are a clique of metabolic disorders caused by a faulty heme-synthesis process. The acute intermittent porphyria (AIP) is the most common type of porphyria. It results from a decrease in the porphobilinogen deaminase enzyme levels (PBG-D) which plays a vital role in the hepatic phase of heme synthesis. Case Report: A 26-years-old lady without any co-morbidity or prior history of any disease came with acute abdominal pain. The causes of acute abdominal pain such as the ectopic pregnancy and other causes were excluded after investigations. She was eventually diagnosed with AIP and managed accordingly. The findings of MRI Brain were suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was treated with hematin, glucose and symptomatic treatment were also given. However, the patient had persistent autonomic dysfunction and hyponatremia, followed by cardiac arrest and death. Conclusion: The diagnosis of AIP is often missed in cases of an acute abdominal pain in pregnant women. Early diagnosis of AIP during pregnancy followed by proper management is associated with favourable maternal and foetal outcome. Delay in the management leads to the worse outcomes like maternal morbidity, mortality or foetal loss

Association of Thyroid Stimulating Hormone and Lipid Profile in Pregnancy

Introduction: Thyroid hormones have significant functions in embryogenesis and fetal development. Evidence suggests that thyroid stimulating hormone (TSH) may exert extra-thyroidal effects and modify the profile of blood lipids. Aim: To determine the association between maternal blood lipid profile and thyroid stimulating hormone in second and third trimester of pregnancy. Methods & Materials: The present study was carried out at MGM Hospital, Navi Mumbai, India. 200 antenatal cases from October, 2012 to October 2014 were enrolled after taking an informed consent. The blood samples for Thyroid stimulating hormone and lipid profile were taken at 16th and 32nd weeks. Results: The mean TSH level in second trimester was 1.53 mIU/L, with a standard deviation of 1.147 mIU/L. In third trimester, the mean TSH level was increased to 2.60 mIU/L with a standard deviation of 0.836mIU/L. The t-stat value was found to be -10.649 (p < 0.001). In third trimester, TSH was negatively correlated with Cholesterol (r= -0.214, p < 0.01) and VLDL (r= -0.148, p < 0.05). Conclusion: TSH levels rises according to the gestational age, being higher in third trimester as compared to second trimester. There is a significant negative correlation between TSH levels and cholesterol & VLDL in third trimester of the pregnancy. Hence, TSH levels should be looked for, especially in third trimester, in order to keep the thyroid related problems in check

Aneurysmal Bone Cyst of Clavicle in a Six-Year-Old Male Child

Aneurysmal Bone Cyst (ABCs) is a cystic expansile lesion which is usually found in solitary locations in the metaphysis of long bones. The most common locations of ABC are long bones of lower limbs. There is little knowledge about the presence of this tumor in Clavicle. Here we present a case of a six year old male child who presented with complaint of swelling in left shoulder for four months. There was a dilemma in the diagnosis of the swelling due to its unusual presentation and appearance. The Fine Needle Aspiration Cytology was also inconclusive. The diagnosis of ABC was made only by excision biopsy. The Clavicle regenerated to nearly normal anatomy at 15 weeks follow up period. The patient is asymptomatic now and is able to perform all daily activities without any restrictions. The uniqueness of this case lies in the fact that this is the first case where ABC has been reported in Clavicular region in young Asian male of less than 10 years age

Welcome to volume 2 of Journal of Medical Research and Innovation

It is my pleasure to introduce the first issue of volume 2 from Journal of Medical Research and Innovation (JMRI). The entire JMRI team is excited to begin our second year journey of publishing good quality-research from across all the medical-related disciplines, all the way from the bench to the bedside. Although we have some quite interesting things planned for 2018, in this Foreword, we will have a look back over some important highlights from volume 1 and some achievements of JMRI from the year 2017

Neuroticism polygenic risk score predicts 20-year burden of depressive symptoms for Whites but not Blacks

Background. Black-White differences are reported in social, psychological, behavioral, medical, and biological correlates of depression. This study was conducted to compare Black and White older adults for the association between neuroticism polygenic risk score (N-PRS) and chronicity of depressive symptoms over 20 years. Methods. Data came from the Health and Retirement Study (HRS), 1990 – 2012, a nationally representative sample of Americans above age 50. Current analysis followed 9,249 individuals (7,924 Whites and 1,325 Blacks) for up to 22 years. Depressive symptoms were measured every two years between 1992 and 2012 using the 8-item Center for Epidemiological Studies-Depression Scale (CES-D-8). The independent variable was N-PRS. The dependent variable was average depressive symptoms between 1992 and 2012. Linear regression was used for data analysis. Results. In the pooled sample, higher N-PRS was associated with higher average depressive symptoms over the 20-year follow up period [b=0.01, 95%CI=0.00 to 0.04], net of all covariates. We also found an interaction between race and N-PRS [b=-0.02, 95%CI=-0.03 to 0.00], suggesting a stronger effect of N-PRS on 20-year average depressive symptoms for Whites than Blacks. Based on our race-specific linear regression models, higher N-PRS was associated with higher depressive symptoms from 1992 to 2012 for Whites [b=0.01, 95%CI=0.01 to 0.02] but not Blacks [b=0.00, 95%CI=-0.02 to 0.02]. Conclusion. Black and White older adults may differ in the salience of the existing N-PRS for depressive symptoms, which better reflects the burden of depression for Whites than Blacks. This may be because the existing PRSs are derived from mostly or exclusively White samples, limiting their applicability in other race groups. Racial variation in psychosocial, clinical, and biological correlates of depression needs further research

Predictors of physician comfort in using pharmacogenomics data in clinical practice: A cross-sectional study

Objective: Utilization of pharmacogenomics data in clinical practice is a critical step towards individual and precision medicine. This is a cross-sectional study conducted by incorporating several variables as outlined in the survey report to assess and analyze the reasons or behaviors that could influence clinicians to use or not use pharmacogenomics. Methods: In this study, we conducted a cross-sectional quantitative survey among primary physicians practicing in Kettering Health Network facilities. 1,201 invitations were sent out and 135 Physicians participated in the survey. Physicians were requested by email to participate in a survey containing 14 multiple choice questions regarding their understanding and beliefs regarding pharmacogenomics, as well as questions about specific professional details which were intended to explore how physician characteristics affected familiarity, and comfort and confidence in using pharmacogenomics data in patient care. Statistical Package for the Social Sciences (standard version 25) was used for statistical analysis and consent was obtained from all study participants through the survey link. Results: The ratings of the familiarly, comfort, and confidence with pharmacogenetics were highly intercorrelated (r = 0.81-0.87).  Accordingly, we summed the three ratings to form a composite score of the three items; hereafter referred to as “scale scores”.  Possible scores ranged from 5 to 15, whereas actual scores ranged from 3 to 15 (Mean = 6.32, SD = 3.12). Scale scores were not statistically significantly correlated with age (r = 0.12, p < 0.17) or number of years in practice (r = 0.11, p < 0.22), and were only weakly (inversely) correlated with number of hours spent in patient care each week (r = -0.17, p < 0.05). Conclusion: In our study, physicians who had some education in the field of pharmacogenomics were more likely to use pharmacogenomics data in clinical practice. We have further characterized that continuing medical education (CME), more than medical education or residency training significantly predicts familiarity, confidence, or comfort in using pharmacogenomics data. Therefore, pharmacogenomics should be integrated in the CME for practicing clinicians as well as graduate medical education