Integrating cardiovascular risk assessment into mobile low-dose CT lung screenings in rural Appalachia: A comprehensive analysis of the relationship between lung cancer risk, coronary artery calcium burden, and cardiovascular risk reduction strategies.

Objective: Mobile low-dose computed tomography (LDCT) lung screenings are part of an outreach program in rural Appalachia to detect early lung cancer. Coronary artery calcium (CAC) scoring on LDCT can identify calcium deposits in coronary arteries and can prompt consideration of risk modification for prevention of cardiovascular disease (CVD) events. It is not known if Lung CT Screening Reporting & Data System (Lung-RADS) scoring correlates with CAC scores. There is no clear guidance for patients undergoing LDCT screenings to receive follow-up regarding CAC or prevention of associated CVD risk. Methods: This was a retrospective review of mobile LDCT LCS in adults with no known history of CVD. CT images were obtained at 100 kVp with a slice thickness of 3 mm. Agatston CAC scoring was performed retroactively. Lung-RADS scores were categorized as: Negative (1), Benign (2), Probably Benign (3), and Suspicious (4). CAC scoring was grouped as 0, 1-100, 101-399, and ≥400. Descriptive statistics and chi-square analyses were utilized. Results: A total of 526 LDCT screenings were included. Over 54 % of patients had coronary calcification on LDCT LCS. 161 patients (30.6 %) had a CAC score of ≥100 and 75 patients (14.3 %) had a CAC score ≥400. Of patients with a CAC score ≥100, 7.5 % received referrals for follow-up after the LDCT screen and 9.3 % had additional cardiac testing. Of those with a CAC score ≥100 not already on a statin (45.3 %) and not already on aspirin (63.3 %), few were started within 3 months of LDCT for prevention (8.2 % and 5.9 % respectively). Among patients with a Lung-RADS score of 4, 17 % had a CAC score >400, whereas only 12 % with a Lung-RADS score of 1 fell into the same CAC category. Higher Lung-RADS scores correlated with fewer patients with CAC of 0. A significant correlation was observed between higher Lung-RADS scores and elevated CAC scores (p = 0.02). Conclusion: In patients with no CVD history, coronary artery calcification was frequently identified on mobile LDCT lung screenings in rural communities. Patients with higher probabilities of malignant lung nodules may also be at increased risk for significant coronary artery disease. Calcium scoring from LDCT screenings allowed for simultaneous assessment of lung cancer and CVD risk. Unfortunately, few referrals or CVD prevention medications were initiated. Awareness of CAC score utility, follow-up for identified coronary calcifications, and consideration of primary prevention medications when indicated, would be beneficial in patients undergoing LDCT lung screenings, especially in rural areas with limited healthcare access.

Lyme Carditis: A Rare Case of Heart Failure in the Absence of Ischemic Heart Disease.

BACKGROUND Lyme carditis typically presents with atrio-ventricular block; however, other cardiac manifestations, including varying EKG changes, myopericarditis and new-onset heart failure, can occur. CASE REPORT We report a case of a 52-year-old woman with past medical history significant for hypertension, chronic obstructive pulmonary disease, and chronic back pain who presented with new-onset heart failure in the setting of Lyme carditis. She presented with exertional dyspnea requiring supplemental oxygen, subjective fever, chills, fatigue, and arthralgia of 2-week duration. Her vital signs were consistent with hypotension and persistent bradycardia. An EKG displayed T-wave flattening in the anterior pre-cordial leads. Further work-up was suggestive of bilateral pulmonary edema and interstitial infiltrates, which required antibiotics and diuretics. Echocardiography demonstrated new-onset mildly depressed LV systolic dysfunction. Interestingly, coronary CTA revealed coronary arteries with no evidence of stenosis or plaque. She was found to have positive Lyme IgM and lgG antibodies. A diagnosis of Lyme myocarditis was considered and her antibiotic course was extended following multidisciplinary consensus. CONCLUSIONS This case report seeks to create awareness of the varying and atypical presentations of Lyme carditis, including new-onset heart failure in a patient without prior history of ischemic heart disease and uncommon EKG changes.

In-Hospital Formula Supplementation in Appalachian Women Intending to Exclusively Breastfeed.

OBJECTIVE: In-hospital formula supplementation places infants at risk for early breastfeeding cessation. The study's aim was to identify predictive and protective factors for in-hospital formula supplementation in individuals documented as wanting to exclusively breastfeed and residing in a geographic region with adverse social determinants of health and low breastfeeding rates. Additionally, we wished to determine if lactation consultation served as a protective factor against supplementation. METHODS: In this cross-sectional study, we retrospectively reviewed 500 randomly selected charts of newborns born in a 12 month period at a regional tertiary care hospital. We included healthy, full-term neonates having a recorded maternal decision to exclusively breastfeed. Maternal-newborn dyad characteristics were compared between those exclusively breastfeeding and those with in-hospital formula supplementation. RESULTS: Of the 500 charts, 70% of individuals desired to exclusively breastfeed. Overall, 41% of breastfed newborns were supplemented with formula before discharge, and 32% of women met with lactation consultants prior to supplementation. No statistically significant association was present between exclusive breastfeeding at discharge and meeting with a hospital lactation consultant (p = 0.55). When controlling for the confounders of maternal demographics and lactation consultation, significant associations with formula supplementation included Cesarean delivery (odd ratio: 2.08, 95% confidence interval: 1.04-4.16), primiparity (2.48, 1.27-4.87), and high school level of education (2.78, 1.33-5.78). CONCLUSIONS: Maternal characteristics of high school level educational, primiparity, and Caesarean delivery place individuals at risk for in-hospital formula supplementation in individuals wishing to exclusively breastfeed. Addressing barriers to exclusive breastfeeding is essential to enhance maternal and newborn health equity.

Measurement-based Care in Psychiatry-Past, Present, and Future.

The authors define measurement-based care (MBC) in psychiatry as the use of validated clinical measurement instruments to objectify the assessment, treatment, and clinical outcomes, including efficacy, safety, tolerability, functioning, and quality of life, in patients with psychiatric disorders. MBC includes two processes: routine assessments, such as measuring the severity of symptoms with rating scales, and the use of assessments in decision-making. MBC implementation was tested in the Texas Medication Algorithm Project and the German Algorithm Project and has been shown to improve patient outcomes. Even though more recent research has shown the many benefits of MBC compared to the usual care, MBC is still not the standard of care in psychiatric practice. This review article addresses the advantages of MBC, the barriers to implementing MBC in clinical practice, and the basic properties of MBC instruments. Recent developments in the 21st century that are expected to accelerate the adoption of MBC in clinical practice, including electronic health records, health information technology, and the development of the Standard for Clinicians' lnterview in Psychiatry (SCIP) as an MBC tool, will be reviewed. The authors recommend including MBC in psychiatry residency training to promote its use in future generations.

Altering bioelectricity on inhibition of human breast cancer cells.

BACKGROUND: Membrane depolarization is associated with breast cancer. Depolarization-activated voltage-gated ion channels are directly implicated in the initiation, proliferation, and metastasis of breast cancer. METHODS: In this study, the role of voltage-gated potassium and calcium ion channel modulation was explored in two different invasive ductal human carcinoma cell lines, MDA-MB-231 (triple-negative) and MCF7 (estrogen-receptor-positive). RESULTS: Resting membrane potential is more depolarized in MCF7 and MDA-MB-231 cells compared to normal human mammary epithelial cells. Increasing extracellular potassium concentration up to 50 mM depolarized membrane potential and greatly increased cell growth. Tetraethylammonium (TEA), a non-specific blocker of voltage-gated potassium channels, stimulated growth of MCF7 cells (control group grew by 201 %, 1 mM TEA group grew 376 %). Depolarization-induced calcium influx was hypothesized as a requirement for growth of human breast cancer. Removing calcium from culture medium stopped growth of MDA and MCF7 cells, leading to cell death after 1 week. Verapamil, a blocker of voltage-gated calcium channels clinically used in treating hypertension and coronary disease, inhibited growth of MDA cells at low concentration (10-20 µM) by 73 and 92 % after 1 and 2 days, respectively. At high concentration (100 µM), verapamil killed >90 % of MDA and MCF7 cells after 1 day. Immunoblotting experiments demonstrated that an increased expression of caspase-3, critical in apoptosis signaling, positively correlated with verapamil concentration in MDA cells. In MCF7, caspase-9 expression is increased in response to verapamil. CONCLUSIONS: Our results support our hypotheses that membrane depolarization and depolarization-induced calcium influx stimulate proliferation of human breast cancer cells, independently of cancer subtypes. The underlying mechanism of verapamil-induced cell death involves different caspases in MCF7 and MDA-MB-231. These data suggest that voltage-gated potassium and calcium channels may be putative targets for pharmaceutical remediation in human invasive ductal carcinomas.