Targeted proteomic profiling of cardiogenic shock in the cardiac intensive care unit.

AIMS: We sought to characterize circulating protein biomarkers associated with cardiogenic shock (CS) using highly multiplex proteomic profiling. METHODS AND RESULTS: This analysis employed a cross-sectional case-control study design using a biorepository of patients admitted to a cardiac intensive care unit between 2017 and 2020. Cases were patients adjudicated to have CS, and controls were those presenting for cardiac critical care without shock, including subsets of patients with isolated hypotension or heart failure (HF). The Olink platform was used to analyse 359 biomarkers with Bonferroni correction. The analysis included 239 patients presenting for cardiac critical care (69 cases with CS, 170 non-shock controls). A total of 63 biomarkers (17.7%) were significantly associated with CS after Bonferroni correction compared with all controls. Of these, nine biomarkers remained significantly associated with CS when separately cross-validated in subsets of controls presenting with isolated hypotension and HF: cathepsin D, fibroblast growth factor (FGF)-21 and -23, growth differentiation factor (GDF)-15, insulin-like growth factor-binding protein-1, N-terminal pro-B-type natriuretic peptide, osteopontin, oncostatin-M-specific receptor subunit beta (OSMR), and soluble ST2 protein (sST2). Four biomarkers were identified as providing complementary information for CS diagnosis with development of a multi-marker model: sST2, FGF-23, CTSD, and GDF-15. CONCLUSION: In this pilot study of targeted proteomic profiling in CS, we identified nine biomarkers significantly associated with CS when cross-validated against non-shock controls including those with HF or isolated hypotension, illustrating the potential application of a targeted proteomic approach to identify novel candidates that may support the diagnosis of CS.

Magnetic Resonance Spectroscopy of Hypoxic-Ischemic Encephalopathy After Cardiac Arrest.

BACKGROUND AND OBJECTIVES: To correlate brain metabolites with clinical outcome using magnetic resonance spectroscopy (MRS) in patients undergoing targeted temperature management (TTM) after cardiac arrest and assess their relationships to MRI and EEG variables. METHODS: A prospective cohort of 50 patients was studied. The primary outcome was coma recovery to follow commands. Comparison of MRS measures in the posterior cingulate gyrus, parietal white matter, basal ganglia, and brainstem were also made to 25 normative controls. RESULTS: Fourteen of 50 patients achieved coma recovery before hospital discharge. There was a significant decrease in total N-acetylaspartate (NAA/Cr) and an increase in lactate/creatine (Lac/Cr) in patients who did not recover, with changes most prominent in the posterior cingulate gyrus. Patients who recovered had decrease in NAA/Cr as compared to controls. NAA/Cr had a strong monotonic relationship with MRI cortical apparent diffusion coefficient (ADC); Lac level exponentially increased with decreasing ADC. EEG suppression/burst suppression was strongly associated with Lac elevation. DISCUSSION: NAA and Lac changes are associated with clinical/MRI/EEG changes consistent with hypoxic-ischemic encephalopathy (HIE) and are most prominent in the posterior cingulate gyrus. NAA/Cr decrease observed in patients with good outcomes suggests mild HIE in patients asymptomatic at hospital discharge. The appearance of cortical Lac represents a deterioration of aerobic energy metabolism and is associated with EEG background suppression, synaptic transmission failure, and severe, potentially irreversible HIE. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients undergoing TTM after cardiac arrest, brain MRS-determined decrease in total NAA/Cr and an increase in Lac/Cr are associated with an increased risk of not recovering.

MRI-EEG correlation for outcome prediction in postanoxic myoclonus: A multicenter study.

OBJECTIVE: To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA). METHODS: Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge. Clinical examination included brainstem reflexes and motor activity. EEG was assessed for best background continuity, reactivity, presence of epileptiform activity, and burst suppression with identical bursts (BSIB). MRI was examined for presence of diffusion restriction or fluid-attenuated inversion recovery changes consistent with anoxic brain injury. A prediction model was developed using optimal combination of variables. RESULTS: Among 78 patients, 11 (14.1%) recovered at discharge and 6 (7.7%) had good outcome (Cerebral Performance Category < 3) at 3 months. Patients who followed commands were more likely to have pupillary and corneal reflexes, flexion or better motor response, EEG continuity and reactivity, no BSIB, and no anoxic injury on MRI. The combined EEG/MRI variable of continuous background and no anoxic changes on MRI was associated with coma recovery at hospital discharge with sensitivity 91% (95% confidence interval [CI], 0.59-1.00), specificity 99% (95% CI, 0.92-1.00), positive predictive value 91% (95% CI, 0.59-1.00), and negative predictive value 99% (95% CI, 0.92-1.00). CONCLUSIONS: EEG and MRI are complementary and identify both good and poor outcome in patients with PAM with high accuracy. An MRI should be considered in patients with myoclonus showing continuous or reactive EEGs.

MTHFR A1298C and C677T Polymorphisms Are Associated with Increased Risk of Venous Thromboembolism: A Retrospective Chart Review Study.

BACKGROUND: Methylene tetrahydrofolate reductase (MTHFR) is a key enzyme in homocysteine metabolism. This study aims to determine the impact of MTHFR polymorphisms on plasma homocysteine levels and risks of venous thromboembolism (VTE). METHODS: This retrospective chart review study included a total of 188 subjects who were tested for MTHFR polymorphisms at Metrowest Coagulation Laboratory between April 2011 and April 2016. Two independent coders were trained to extract relevant clinical data for statistical analysis. RESULTS: VTE occurred in 50% of patients with compound mutation, compared with only 28.6% of subjects from the wild-type group. Patients with heterozygous or homozygous A1298C or C677T variants had an intermediate risk of VTE. The median homocysteine level in the wild-type group was slightly lower than that of heterozygous or homozygous MTHFR variants. The difference, however, was not significant (p = 0.6193). Moreover, there was no difference in plasma homocysteine level between patients with VTE versus VTE-free (p = 0.4923). CONCLUSIONS: Heterozygous or homozygous MTHFR variants, especially a compound mutation, are associated with increased risk of VTE. Hyperhomocysteinemia does not correlate with MTHFR polymorphisms or VTE risk. Hence, MTHFR genotyping provides more consistent assessment of VTE risk. This information can be incorporated into risk stratification for early intervention and prophylaxis of VTE.

A resiliência como constructo à práxis da enfermagem: inquietações reflexivas / Resilience as a construct in nursing practice: reflective concerns / La resiliencia como constructo en la práctica de enfermería: inquietudes reflexivas

Trata-se de uma reflexão teórica sobre resiliência como conceito a ser considerado no cuidado de Enfermagem às pessoas em condição crônica. Resiliência tem se revelado como uma capacidade que promove a superação das adversidades do processo de viver. No estudo são discutidas multiversas compreensões sobre resiliência, à luz da literatura especializada, apresentando uma relação do conceito epistemologicamente intercruzado às abordagens psicanalíticas, desenvolvimentais, omportamentais, clínicas e socioeducativas contemporâneas. O estudo realça a necessidade de compreender as características do ser com implicações às dimensões internas e externas ao seu processo de viver-adoecer humano ­ os elementos pessoais do ser resiliente, que podem ser incorporados como mais uma possibilidade na práxis dos cuidados profissionais em saúde, em destaque a Enfermagem ­ recomendando a necessidade de reconhecer a contribuição do conceito resiliência para a indispensável mudança de paradigma em ciências da saúde, deslocando o foco da doença para a aquiescência das potencialidades da pessoa em sua inteireza e globalidade, as suas respostas adaptativas frente às adversidades no processo de viver humano ­ uma doença, como as de natureza crônica, sendo a palavra-chave trabalhar as potencialidades e os modos de proteção das pessoas em face ao enfrentamento da condição crônica.

This is a theoretical reflection on resilience as a concept to be considered in nursing care for people with a chronic condition. Resilience has been revealed as a capability that promotes the overcoming of adversities in living processes. In this study, multiple views of resilience are discussed in the light of specialized literature, presenting a relationship to the concept that is epistemologically intercrossed with the psychoanalytic, developmental, behavioral, clinical and socio-educational contemporary approaches. The study highlights the need to understand the characteristics of the implications with the internal and external dimensions of the human living-sicken process; the personal elements of being resilient, which can be incorporated as another possibility in the practice of health care by professionals, mainly in Nursing. This reflection highlights and recommends the need to recognize the contribution of the resilience concept into the indispensable paradigm change in health sciences by disarticulating the current perspective focus in the disease and acquiring the potentialities of the person in its integrality and holism who are facing the normal adversities in the human livingsicken process such as chronic diseases, being the keyword, and by working with the capabilities and the protecting factors of persons experiencing a chronic condition.

Se trata de una reflexión teórica sobre resiliencia como concepto a ser considerado en el cuidado de Enfermería dirigido hacia personas en condición crónica. La resiliencia ha sido revelada como la capacidad que promueve la superación de las adversidades en el proceso vivir. Este estudio discute múltiples comprensiones sobre resiliencia, a la luz de la literatura especializada, presentado una relación de conceptos epistemológicamente entrecruzados con los abordajes psicoanalíticos, desenvolvimentales, conductuales, clínicos y socioeducativos contemporáneos. El estudio resalta la necesidad de comprender las características del ser con implicaciones en las dimensiones internas y externas en el proceso vivir-enfermar humano ­ los elementos personales del ser resiliente, que pueden ser incorporados como una posibilidad mas en la praxis de los cuidados profesionales en salud, principalmente en Enfermería. Se recomienda la necesidad de reconocer la contribución del concepto resiliencia para la indispensable mudanza del paradigma en ciencias de salud, desarticulando el foco de enfermedad en la aceptación de las potencialidades de la persona en su integralidad y globalidad, las respuestas adaptativas frente a las adversidades en el proceso vivir humano ­ enfermar; como las de naturaleza crónica-, siendo la palabra llave trabajar con las potencialidades y los modos de protección de las personas de cara al enfrentamiento de la condición crónica.

Estratégias de enfrentamento familiar do diagnóstico de leucemia: aspectos sociais e religiosos / Family coping strategies for leukemia diagnosis: social and religious aspects

Objetivo: analisar o discurso dos familiares de crianças com leucemia quanto ao enfrentamento da doença. Método: estudo exploratório-descritivo, com abordagem qualitativa, realizado com nove acompanhantes entre março e maio de 2012. Os dados foram produzidos a partir de entrevista semiestruturada, gravada e transcrita; em seguida, para a análise, utilizou-se a análise temática: ordenação, classificação e análise propriamente dita. O projeto foi aprovado pelo Comitê de Ética em Pesquisa, Protocolo 0046. Resultados: identificou-se que muitos pais se culpam pelo surgimento da patologia e que a principal fonte de alívio é a religiosidade, relataram a importância do apoio familiar e afirmaram grande mudança no cotidiano devido ao longo tratamento do filho. Conclusão: dependendo da cultura e do meio social do envolvido, formas de enfrentamento podem ser diversificadas, no entanto, o apoio familiar no processo de adoecimento e luta pela cura da doença revelou-se importante.(AU)

Construindo o balance familiar: Uma análise compreensiva da dinâmica familiar com pessoa idosa portadora de Diabetes Mellitus tipo 2 / Building the family balance: A comprehensive analysis of family dynamics with the elderly suffering from Type 2 Diabetes Mellitus

Estudo qualitativo apoiado na interdisciplinaridade dos pressupostos epistemológicos da ciência pós-moderna. Objetivou conhecer como o Diabetes Mellitus Tipo 2 em membro idoso interfere na dinâmica inter-relacional da família. A coleta de dados foi realizada através de instrumentos qualitativos. A análise dos dados baseou-se no modelo interativo desenvolvido por Miles e Huberman. Conclui-se que a doença tem influência nas inter-relações, no contexto histórico e sociocultural da família...

This qualitative study was based on the interdisciplinary of the epistemological assumptions of the postmodern science. It aimed to understand how the Type 2 Diabetes Mellitus in the elderly interferes with the inter-relational family dynamics. Data collection was conducted through qualitative instruments. Data analysis was based on the interactive model developed by Miles and Huberman. We concluded that the disease has an effect on the inter-relationships, the historical, social and cultural context of the family...

[Family, a care unit for its members: reflexive concerns]. / Família uma unidade de cuidado para seus membros: inquietações reflexivas.

This reflection has searched through a brief historic perspective, to understand the family as a care unit for its members. It has as objective, to awake a health professional's more conscientious new look for the care to elderly people in chronical condition, aiming to extend this look to the family as a unit care. This reflexion leans on Systemic Thought, that is, on the comprehension that the family isn't the sum of parts, but pressuposes the whole and the parts at the same time, thus it isn't possible to see the individual only without looking at the family as a whole in the dynamical relations and interactions between them. After the realized re-reading it became that it's necessary to rethink new strategies to approach the care to the bearer of a chronic disease such as diabetes, that embrace the whole family as focus attention of its members health, considering the complexity, intersubjectivity and instability of the new pos-modern science paradigm.

Arte na enfermagem: iniciando um diálogo reflexivo / Art in nursing: initiating a reflexive dialogue

Este artigo tem a intenção de iniciar um diálogo reflexivo sobre a enfermagem como ciência e como arte, contidas nas atividades dos enfermeiros, sejam elas de assistência, pesquisa e ensino. Baseado na ética e arte como forma de exercício do cuidar de enfermagem para a ação humana, este tem como objetivo contribuir para uma reflexão do "saber fazer" profissional de modo contextualizado, integralizado e atual.