Acute Stanford Type A Aortic Dissection: A Review of Risk Factors and Outcomes.

Acute aortic dissection (AAD) can be said to be a relatively uncommon emergency with fatal outcomes mainly due to delayed/missed diagnosis and treatment. Its ability to masquerade as other emergencies like acute coronary syndrome and pulmonary embolism makes the prognosis unfavorable in a significant proportion of patients. Patients have been seen to present to the accident and emergency department or outpatient setting with typical or atypical symptoms as we will discuss in this article. We have focused on indicators for risk and prognosis of acute Stanford type A aortic dissection in this traditional review. It is well known that despite recent developments and improvements in treatment modalities, AAD is still associated with a significant mortality rate and postoperative complications.

The Safety of Minimally Invasive and Open Cholecystectomy in Elderly Patients With Acute Cholecystitis: A Systematic Review.

Elderly patients with acute cholecystitis (AC) often receive no surgical treatment due to a high number of comorbidities and a high risk of operations. With an increasingly aged population worldwide, this systematic review aims to review the safety of minimally invasive cholecystectomy and open cholecystectomy in this population compared to younger patients. A systematic search was conducted on PubMed, PubMed Central, and Google Scholar databases on July 2, 2022. Articles in the English language published in the last five years with free full text and involving elderly patients with AC treated with minimally invasive and open cholecystectomy were selected. Moreover, a quality assessment was carried out by using each study's most commonly used assessment tools. Initially, the search yielded 1,252 potentially relevant articles. After the final selection process, 11 studies were included: one cross-sectional study, eight cohort studies, one case-control study, and one systematic review with meta-analyses. These studies involved a total of 378,986 participants, with 375,623 elderly patients. In the elderly, cholecystitis severity, decreased physical status, and multiple comorbidities increase the risk of complications with cholecystectomy. In addition, the elderly had more complications, open surgery conversions, biliary tract injuries, leaks, postoperative mortality, and hospital length of stay than younger patients. Nevertheless, minimally invasive cholecystectomy is a viable treatment option for elderly patients when performing a thorough perioperative assessment.

Sodium-Glucose Co-transporter 2 Inhibitors/Gliflozins: A New Miracle Therapy for Heart Failure Patients Irrespective of Diabetes Status?

Despite the existence of effective medicines, heart failure continues to be the largest cause of illness and death worldwide. As a prospective family of drugs with potential cardiovascular advantages in non-diabetic patients, sodium-glucose co-transporter 2 inhibitors (SGLT2-I) have recently come to the forefront. In this comprehensive study, we assessed the favorable cardiovascular outcomes of SGLT2-I in three sizable, randomized trials with both diabetic and non-diabetic populations. The results from these studies revealed a substantial reduction in heart failure hospitalizations and cardiovascular and all-cause deaths. To further support our assertion that SGLT2-I has the potential to be a novel addition to the standard treatment plan for heart failure, we also tried to assemble several post hoc and prespecified studies of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. The details of two clinical investigations that supported their use in acute decompensated heart failure were also examined, along with the most plausible mechanism of action generating their cardioprotective effects. Additionally, positive cardiovascular advantages were addressed in chronic heart failure with both preserved and reduced ejection fractions. The role of SGLT2-I in ST-elevation myocardial infarction (STEMI) and hypertrophic cardiomyopathy (HOCM) patients is currently being studied, and this research has the potential to be revolutionary. The purpose of this systematic review is to compile all information that supports the use of this life-saving drug in patients who do not have diabetes so that cardiac care can be improved globally.

Cerebellar Ataxia in the Setting of Hashimoto's Thyroiditis: A Case Report.

Hashimoto's encephalopathy (HE) is a rare diagnosis with a heterogenous presentation. It may not be directly related to thyroid dysfunction as most patients are euthyroid when the symptoms start. There has been a lack of consensus building on the pathophysiology of HE, but most of the evidence points towards autoimmune vasculitis as the underlying process. HE can present as seizures, cognitive dysfunction, tremors, or stroke-like symptoms with focal neurological deficits. Cerebellar ataxia (motor incoordination due to dysfunction of the cerebellum) is seen in HE but is a rare occurrence. The objective of the article was to present a case of cerebellar ataxia in a patient with Hashimoto's thyroiditis. A 30-year-old previously healthy female presented with quickly progressive cerebellar ataxia, bilateral (B/L) limb weakness, and excessive tearing. She was found to have high titers of anti-TPO (anti-thyroid peroxidase) antibodies; a biopsy confirmed Hashimoto's thyroiditis and a battery of negative tests excluding other causes of encephalopathy. Hence, confirming a diagnosis of HE. The patient was given glucocorticoids which relieved her symptoms. After being symptom-free for a few months, she relapsed and was unsuccessfully treated by the steroids. Upon this, she was given IV immunoglobulins, which helped achieve complete resolution. HE can be treated with immunotherapy, and most patients have a good prognosis, but some can have persistent neurological defects if left untreated or treatment is delayed. Relapses are common and may require a more extended treatment regimen.

Assessing integrated biomarkers of triplefin fish Forsterygion capito inhabiting contaminated marine water - A multivariate approach.

The presence of multiple chemicals in aquatic ecosystems makes evaluation of their real impact on the biota difficult. Integrated biomarkers are therefore needed to evaluate how these chemicals contribute to environmental degradation. The aims of the present study were to evaluate responses to and effects of marine pollution using a series of biomarkers through multivariate analyses. Transcriptional responses of cyp1a (cytochrome P450), mt (metallothionein), vtg (vitellogenin) and cyp19b (cytochrome P450 aromatase); branchial and hepatic histological alterations; and Fulton condition factors (CF) were evaluated, as well as the metals and polycyclic aromatic hydrocarbons present in Forsterygion capito in Auckland, New Zealand. Sites were selected along a contamination gradient: four highly contaminated sites and four less contaminated. Molecular responses with a higher relative expression of the mt and cyp1a genes were detected at a highly contaminated site (Panmure). Several histological lesion types were found in the livers of fish inhabiting both types of sites, but gill lesions were present primarily at highly contaminated sites. In terms of general health status, the lowest CF values were overwhelmingly found in fish from the same site (Panmure). The multivariate approach revealed that telangiectasia and hyperplasia were associated with the presence of chemicals, and these showed negative associations with the CF values, with fish from three highly contaminated sites being most affected. In conclusion, the multivariate approach helped to integrate these biological markers in this blennioid fish, thus providing a more holistic view of the complex chemical mixtures involved. Future studies should implement these analyses.

A Systematic Review of CD34+ Stem Cell Therapy as an Innovative and Efficient Treatment for the Management of Refractory Angina.

Despite optimal medical treatment, many individuals suffering from severe coronary artery disease are not suitable candidates for further revascularization. Therapeutic angiogenesis has attracted continuous interest to increase myocardial perfusion. Cell therapy using autologous stem cells expressing Cluster of Differentiation 34 plus (CD34+) offers a special therapeutic choice for individuals with refractory angina, seeing as CD34+ stem cells can restore microcirculation. We searched PubMed, PubMed Central (PMC), and Google Scholar to find the relevant articles to write this systematic review about the role of CD34+ stem cell therapy in the management of refractory angina. Additionally, we provided a brief explanation of CD34+ cells and their mechanism of action. Along with the positive finding of other trials, a recent open-label, single-center intracoronary CD34+ cell therapy for the treatment of coronary endothelial dysfunction in patients with angina and nonobstructive coronary arteries (IMPROvE-CED) clinical trial published in 2022 concluded improvement in coronary blood flow, a significant reduction in daily as-needed sublingual nitroglycerin use and improvement in Canadian Cardiovascular Society (CCS) angina class were observed after autologous CD34+ cell treatment. In conclusion, refractory angina management and overall prognosis may be revolutionized once this treatment is approved.

Emphasis on Icosapent Ethyl for Cardiovascular Risk Reduction: A Systematic Review.

Despite the widespread use of lipid-lowering agents such as statins, cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Icosapent ethyl (IPE) (Vascepa), an ethyl ester of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA), has gained widespread popularity as an adjunctive agent that targets multiple and additional mechanisms linked to the incidence of cardiovascular (CV) events and the causative pathway of atherosclerosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were used to conduct this systematic review. In this review, we assessed various studies from PubMed, PubMed Central (PMC), and Google Scholar to evaluate the mechanisms of action and beneficial effects of IPE in the reduction of CVD outcomes. The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) has demonstrated a significant reduction in CV mortality with 4 g/day IPE as compared to placebo. All other trials and observational studies have supported the role of Vascepa in hypertriglyceridemia and CV risk reduction. In conclusion, the use of IPE has been shown to significantly reduce triglyceride levels and reduce CV risks in patients receiving optimal statin therapy.

Morphological and molecular characterization of larval digenean trematodes (Parvatrema: Gymnophallidae) and their pathological effects on the clam Leukoma thaca (=Protothaca thaca) (Bivalvia:Veneridae) (Molina, 1782) from northern Chile.

Trematodes are one of the largest taxa of mollusk parasites. The clam Leukoma thaca is an economically exploited bivalve found along the south-eastern Pacific coast of Peru and Chile. This bivalve is parasitized by various unidentified larval stages of digeneans in the mantle, gonads and digestive gland. The aims of this study were to determine and describe the different larval stages of the digeneans based on morphological characteristics, to identify them at the species level by performing molecular analyses, and to evaluate pathologies associated with the parasites of this clam. Individuals of L. thaca were collected in San Jorge Bay (23°S), Chile, between November 2018 and February 2019. Morphological description was carried out using in vivo and fixed specimens, and analyses including histological and scanning electron microscopy were performed. Individuals were also isolated for molecular analysis using nuclear ribosomal internal transcribed spacer 1 (ITS1), including partial subunit 18S rDNA (18S) and small subunit 5.8S gene (5.8S). Morphological characteristics indicated that the metacercaria larval stage belongs to the family Gymnophallidae, genus Parvatrema, which was supported by molecular analysis. Molecular results revealed that metacercaria, sporocysts and cercaria stages found in this clam belong to the same species of Parvatrema (genetic distance 0%), evidencing that this species uses L. thaca as the first and second intermediate host. Pathologies examined in the host were similar in nature to those reported in other gymnophallids in bivalves, but high prevalence of cercariae (20%) in gonads suggested an important castrator effect on the host.

Phase II Trial of Palbociclib in Recurrent Retinoblastoma-Positive Anaplastic Oligodendroglioma: A Study from the Spanish Group for Research in Neuro-Oncology (GEINO).

BACKGROUND: The cell cycle checkpoint G1/S, dependent on cyclin-dependent kinase (CDK) 4 amplification/overexpression and retinoblastoma phosphorylation, is altered in most anaplastic oligodendrogliomas (AOs). OBJECTIVE: We aimed to evaluate the efficacy of palbociclib, an oral inhibitor of CDK4/6 with proven efficacy in breast cancer, in patients with AO. The primary endpoint was progression-free survival at 6 months. PATIENTS AND METHODS: We conducted a multicenter, open-label, phase II trial evaluating the efficacy and safety of palbociclib in patients with AO who progressed on radiotherapy and chemotherapy with histologically and molecularly confirmed grade 3 oligodendroglioma and conserved retinoblastoma protein (pRb) expression by immunohistochemistry. Patients were treated with palbociclib (125 mg/day) for 3/1 weeks on/off. RESULTS: Overall, 34 patients were enrolled across 10 hospitals in the Spanish Group of Neuro-Oncology (GEINO) study. The study was stopped early owing to the lack of efficacy, with 74% of evaluable patients progressing within 6 months, which was insufficient to consider palbociclib as an active drug in this population. Within the median follow-up of 12 months, the median progression-free survival was 2.8 months [95% confidence interval (CI) 2.6-3.1] and the median overall survival was 32.1 months (95% CI 5.1-59.2). There were no partial or complete responses; only 13 patients (38%) achieved stable disease as the best response. Palbociclib was well tolerated, with neutropenia (grade 3 or higher: 58.8%) and thrombocytopenia (grade 3 or higher: 14.7%) as the most common adverse events (AEs). Both AEs had no significant impact. CONCLUSION: Despite the good tolerance, palbociclib monotherapy did not show favorable efficacy against recurrent AO. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, identifier NCT0253032 (retrospectively registered on 21 August 2015).

Persistent asymptomatic or mild symptomatic hyperCKemia due to mutations in ANO5: the mildest end of the anoctaminopathies spectrum.

BACKGROUND: The ANO5 gene encodes for anoctamin-5, a chloride channel involved in muscle cell membrane repair. Recessive mutations in ANO5 are associated with muscular diseases termed anoctaminopathies, which are characterized by proximal or distal weakness, or isolated hyperCKemia. We present the largest series of patients with asymptomatic/paucisymptomatic anoctaminopathy reported so far, highlighting their clinical and radiological characteristics. METHODS: Twenty subjects were recruited retrospectively from the Neuromuscular Disorders Units database of two national reference centers. All had a confirmed genetic diagnosis (mean age of diagnosis was 48 years) established between 2015 and 2019. Clinical and complementary data were evaluated through clinical records. RESULTS: None of the patients complained about weakness or showed abnormal muscular balance. Among paucisymptomatic patients, the main complaints or findings were generalized myalgia, exercise intolerance and calf hypertrophy, occasionally associated with calf pain. All patients showed persistent hyperCKemia, ranging from mild-moderate to severe. Muscle biopsy revealed inflammatory changes in three cases. Muscle magnetic resonance imaging revealed typical signs (preferential involvement of adductor and gastrocnemius muscles) in all but one patient. In two cases, abnormal findings were detectable only in STIR sequences (not in T1). Three patients showed radiological progression despite remaining asymptomatic. Twelve different mutations in ANO5 were detected, of which seven are novel. CONCLUSIONS: Recessive mutations in ANO5 are a frequent cause of undiagnosed asymptomatic/paucisymptomatic hyperCKemia. Patients with an apparent indolent phenotype may show muscle involvement in complementary tests (muscle biopsy and imaging), which may progress over time. Awareness of anoctaminopathy as the cause of nonspecific muscular complaints or of isolated hyperCKemia is essential to correctly diagnose affected patients.

A non-invasive method to monitor marine pollution from bacterial DNA present in fish skin mucus.

Marine coastal contamination caused by human activity is a major issue worldwide. The implementation of effective pollution monitoring programs, especially in coastal areas, is important and urgent. The use of biological, physiological, or biochemical measurements to monitor the impacts of pollution has garnered increasing interest, particularly for the development of new non-invasive tools to assess water pollution. Fish skin mucus is in direct contact with the marine environment, making it a favourable microenvironment for the formation of biofilm bacterial communities. In this study, we developed a non-invasive technique, sampling fish skin mucus to determine and analyse bacterial community composition using next-generation sequencing. We hypothesised that bacterial communities associated with the skin mucus of a common harbour benthic blennioid triplefin fish, Forsterygion capito, would reflect conditions of different marine environments. We detected clear differences in bacterial community alpha-diversity between contaminated and reference sites. Beta-diversity analysis also revealed differences in the bacterial community structure of the skin mucus of fish inhabiting different geographical areas. The relative abundance of different bacterial orders varied among sites, as determined by linear discriminant analysis (LDA) and effect size (LEfSe) analyses. The observed variation in bacterial community compositions correlated more strongly with variation in hydrocarbons than to various metal concentrations. Using advanced DNA sequencing technologies, we have developed a novel non-invasive, low-cost and effective tool to monitor the impacts of pollution through analysis of the bacterial communities associated with fish skin mucus.

Histopathological lesions, pathogens and parasites as health indicators of an edible clam (Protothaca thaca) inhabiting a bay exposed to anthropogenic activities in Northern Chile.

San Jorge Bay (23° S) is characterised by a permanent coastal upwelling front and a thermal front that influence water circulation into the bay. This bay constantly receives effluents from different mining activities. Several studies have demonstrated different levels of heavy metals in waters and sediments within the bay. The clam Protothaca thaca is a bivalve with sedentary habits, which is distributed along the Peruvian and Chilean coasts and is exploited commercially. During 2010, clams were collected inside the bay: north (La Chimba), centre (Paraíso) and south (Llacolén), as well as from a site outside the bay (Bolsico). Haematological parameters, condition factor index, lesions, parasites and pathogens and heavy metal concentrations in clam tissues were determined. The health indicators of clams inhabiting the bay varied between sites. Clams inside the bay showed higher prevalence and intensity of parasites and lesions than those clams inhabiting the site outside the bay, which could be indicating the presence of some environmental stressor (e.g. heavy metals). This study is the first to evaluate the health status of organisms from San Jorge Bay, and our results support the hypothesis that clams P. thaca can be used to evaluate environmental quality.

Bethlem myopathy: a series of 16 patients and description of seven new associated mutations.

BACKGROUND: Bethlem myopathy represents the milder phenotype of collagen type VI-related myopathies. However, clinical manifestations are highly variable among patients and no phenotype-genotype correlation has been described. We aim to analyse the clinical, pathological and genetic features of a series of patients with Bethlem myopathy, and we describe seven new mutations. METHODS: A series of 16 patients with the diagnosis of Bethlem myopathy were analyzed retrospectively from their medical records for clinical, creatine kinase (CK), muscle biopsy, and muscle magnetic resonance (MRI) data. Genetic testing was performed through next-generation sequencing of custom amplicon-based targeted genes panel of myopathies. Mutations were confirmed by Sanger sequencing. RESULTS: The most frequent phenotype consisted of proximal limb weakness associated with interphalangeal and wrists contractures. However, cases with isolated contractures or isolated myopathy were found. CK levels did not correlate with severity of the disease. The most frequent mutation was the COL6A3 variant c.7447A>G, p.Lys2486Glu, with either an homozygous or compound heterozygous presentation. Five new mutations were found in COL6A1 gene and other two in COL6A3 gene, all of them with a dominant heritability pattern. From these, a new COL6A1 mutation (c.1657G>A, p.Glu553Arg) was related to an oligosymptomatic phenotype with predominating contractures in the absence of weakness and a normal muscle MRI. Finally, the most common COL6A1 mutation reported to date that leads to an Ullrich phenotype (c. 868G>A, p.Gly290Arg), has been found here as Bethlem presentation. CONCLUSIONS: Manifestations of Bethlem myopathy are quite variable, so either contractures or weakness may be lacking, and no phenotype-genotype associations can be brought.

Variables asociadas a abuso físico y psicológico a la pareja / Associated variables with partner physical and psychological abuse / Variáveis associadas a abuso físico e psicológico ao casal

El abuso físico y el abuso psicológico representan un problema de salud pública frecuente en mujeres colombianas. No obstante, pocas investigaciones exploran las variables asociadas en mujeres adultas. Objetivo: establecer variables psicosociales asociadas a abuso físico y psicológico en mujeres de Bogotá (Colombia). Materiales y métodos: se diseñó un estudio analítico transversal. Se solicitó la participación de mujeres adultas con pareja de estrato socioeconómico bajo. Se aplicaron las escalas: Apgar familiar (disfunción familiar), Escala de Rosenberg (autoestima), Cuestionario General de Salud (GHQ-12, trastornos mentales comunes) e Índice de Abuso a la Pareja (Index of Spouse Abuse, ISA-8, ISA-F e ISA-P). Mediante regresión logística se ajustaron la variables psicosociales asociadas al abuso físico y al abuso psicológico. Resultados: participaron 292 mujeres. La media para la edad fue 33,0 años (DE = 9,23). La prevalencia de baja autoestima fue del 29,1%; de disfunción familiar, del 82,5%; de trastornos mentales comunes, del 73,6%; de abuso psicológico, del 68,5% y de abuso físico, del 70,2%. Los trastornos mentales comunes (OR = 4,0; IC 95% 2,2-7,5), baja autoestima (OR = 2,4; IC 95% 1,2-4,7) y disfunción familiar (OR = 2,3; IC 95% 1,1-4,8) se asociaron a abuso psicológico; y baja autoestima (OR = 2,6; IC 95% 1,4-5,0) y trastornos mentales comunes (OR = 2,4; IC 95% 1,4-4,3) a abuso físico. Conclusiones: es alta la frecuencia de maltrato conyugal en mujeres de estrato socioeconómico bajo de Bogotá. El trastorno mental común y la baja autoestima se asocian a abuso psicológico y a abuso físico.

Physical and psychological abuse (spouse abuse) are a common public health problem in women of Colombia. However, few investigations explore the variables associated in adult women. Objective: To establish psychosocial variables associated with spouse abuse in women in situations of vulnerability Bogotá, Colombia. Materials and methods: A cross-sectional study was designed in which participated of adult women with a current partner dwelling in low socioeconomic status. It was applied the scales: family Apgar (family dysfunction), Rosenberg Scale (self-esteem), General Health Questionnaire (GHQ-12, common mental disorders) and Index of Spouse Abuse (physical abuse, ISA-F and; psychological abuse, ISA-P). Logistic regression was used to adjust associated variables with physical abuse and psychological abuse. Results: A total of 292 women participated. The mean age was 33.0 years (SD = 9.23) and for schooling, 6.7 years (SD = 2.8). The prevalence of 29.1% low self-esteem, family dysfunction was 82.5% of common mental disorders, 73.6%, psychological abuse, 68.5% and physical abuse, 70.2%. Common mental disorders (OR = 4.0, 95% CI 2.2-7.5), low self-esteem (OR = 2.4, 95% CI 1.2-4.7) and family dysfunction (OR = 2.3, 95% IC 1.1-4.8%) were associated with psychological abuse and low self-esteem (OR = 2.6, 95% CI 1.4-5.0) and; common mental disorders (OR = 2.4, 95% CI 1.3-4.4) with physical abuse. Conclusions: It is high the frequency of physical abuse and psychological abuse (spouse abuse) among women of low socioeconomic status of Bogotá. Common mental disorders and low self-esteem are associated with spouse abuse.

O abuso físico e o abuso psicológico representam um problema de saúde pública freqüente em mulheres colombianas. Não obstante, poucas pesquisas exploram as variáveis associadas em mulheres adultas. Objetivo: estabelecer variáveis psicossociais associadas a abuso físico e psicológico em mulheres de Bogotá, Colômbia. Materiais e métodos: criou-se um estudo analítico transversal. Solicitou-se a participação de mulheres adultas com cônjuge de estrato sócio-econômico baixo. Aplicaram-se as escalas: APGAR (disfunção familiar), escala de Rosenberg (auto-estima), Questionário de Saúde Geral (GHQ-12, transtornos mentais comuns) e Index of Spouse Abuse (ISA-8, ISA-F e ISA-P). Mediante regressão logística se ajustaram a variáveis psicossociais associadas ao abuso físico e ao abuso psicológico. Resultados: participaram 292 mulheres. A média para a idade foi 33,0 anos (DE=9,23). A prevalência de baixa auto-estima de 29,1%, de disfunção familiar foi 82,5%; de transtornos mentais comuns, 73,6%; de abuso psicológico, 68,5% e de abuso físico, 70,2%. Os transtornos mentais comuns (OR=4,0; IC95% 2,2-7.5), baixa auto-estima (OR=2,4; IC95% 1,2-4.7) e disfunção familiar (OR=2,3; IC95% 1,1-4.8) se associaram a abuso psicológico; e baixa auto-estima (OR=2,6; IC95% 1,4-5,0) e transtornos mentais comuns (OR=2,4; IC95% 1,4-4.3) a abuso físico. Conclusões: é alta a freqüência de abuso conjugal em mulheres de estrato sócio-econômico baixo de Bogotá. Transtorno mental comum e baixa auto-estima se associam a abuso psicológico e abuso físico.