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COVID-19 , Cardiopatias Congênitas , Pneumonia Bacteriana , Humanos , Mortalidade Hospitalar , Dilatação , Ecocardiografia , CardiomegaliaRESUMO
Background: Although right ventricular (RV) dysfunction is associated with mortality in acute COVID-19, the role of RV dilation is uncertain. The prognostic significance of RV dilation and dysfunction among hospitalized patients with acute COVID-19 compared to other respiratory illnesses. Methods: We conducted a retrospective cohort study to examine 225 consecutive adults admitted for acute COVID-19 and 6,150 control adults admitted for influenza, pneumonia or ARDS who had a clinical echocardiogram performed. We used logistic regression models to assess associations between RV parameters and in-hospital mortality adjusted for confounders. Results: Among those with COVID-19, 48/225 (21.3%) died during the index hospitalization compared to 727/6150 (11.8%) with other respiratory illness (p=0.001). Independent of COVID-19, mild and moderate to severe RV dilation were associated with 1.4 and 2.0 times higher risk of inpatient mortality, respectively (95%CI 1.17 to 1.69; p=0.0003; 95%CI 1.62 to 2.47; p<0.0001, respectively). Similarly, mild and moderate RV dysfunction were associated with 1.4 and 1.7 times higher risk of inpatient mortality (95%CI 1.10 to 1.77; p=0.007; 95%CI 1.17 to 2.42; p=0.005, respectively). Relative to normal RV size and non-COVID-19 acute respiratory illness, mild and moderate RV dilation were associated with 1.4 times and 2.0 times higher risk among those without COVID-19 and 1.9 times higher and 3.0 times higher risk among those with COVID-19, with similar findings for RV dysfunction. Having both RV dilation and dysfunction or RV dilation alone were associated with 1.7 times higher risk while RV dysfunction alone was associated with 1.4 times higher risk compared to normal RV size and function. Conclusions: RV dilation and dysfunction are associated with increased risk of inpatient mortality among those with COVID-19 and other respiratory illnesses. Abnormal RV findings may identify those at higher risk of short-term mortality from acute respiratory illness including COVID-19 beyond other risk markers.
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OBJECTIVES: Peripheral artery disease (PAD) is associated with decreased physical function and increased mortality in the general population. We previously found that PAD is common in middle-aged women with and without HIV infection, but its association with functional decline is unclear. We examine the contribution of PAD to functional decline in the Women's Interagency HIV Study, controlling for traditional cardiovascular risk factors and HIV-related factors. METHODS: Analysis included 1839 participants (72% with HIV) with measured ankle-brachial index (ABI) and 4âm gait speed. ABI values categorized PAD severity. Linear models with repeated measures estimated the association of PAD severity with log-transformed gait speed after controlling for demographic, behavioral, and metabolic risk factors, and HIV/hepatitis C virus status. RESULTS: Median age was 50 years and more than 70% were Black. Compared with normal ABI, there was a dose-response relationship between increasing PAD severity and slower gait speed in univariable analyses: 6% slower gait speed for low-normal ABI [95% confidence interval (CI): 4-9%], 10% for borderline PAD (95% CI: 6-13%), 14% for mild PAD (95% CI: 9-18%), and 16% for moderate-severe PAD (95% CI: 5-25%). PAD severity remained associated with slower gait speed in multivariable analyses. HIV/hepatitis C virus co-infection was independently associated with 9% (95% CI: 4-14%) slower gait speed compared with those with neither infection. Among women with HIV, neither CD4+ cell count nor HIV-RNA level was associated with gait speed. CONCLUSION: In middle-aged women with and without HIV infection, greater PAD severity is associated with progressively slower gait speed. Early detection of subclinical PAD may decrease the risk of lower extremity functional impairment and its long-term health consequences.
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Infecções por HIV , Doença Arterial Periférica , Índice Tornozelo-Braço , Feminino , Infecções por HIV/complicações , Humanos , Extremidade Inferior/irrigação sanguínea , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Fatores de Risco , Caminhada/fisiologiaAssuntos
Arritmias Cardíacas/terapia , Cateterismo Cardíaco/métodos , Estimulação Cardíaca Artificial/efeitos adversos , Eletrocardiografia , Marca-Passo Artificial/efeitos adversos , Idoso de 80 Anos ou mais , Arritmias Cardíacas/fisiopatologia , Falha de Equipamento , Feminino , Frequência Cardíaca , HumanosRESUMO
Carcinoid crisis is a life-threatening manifestation of carcinoid syndrome characterized by profound autonomic instability in the setting of catecholamine release from stress, tumor manipulation, or anesthesia. Here, we present an unusual case of carcinoid crisis leading to acute systolic heart failure requiring mechanical circulatory support. (Level of Difficulty: Intermediate.).
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OBJECTIVES: HIV and hepatitis C virus (HCV) have been associated with cardiovascular disease (CVD), but it is unclear whether HIV and HCV are also associated with peripheral artery disease (PAD). We examined the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women's Interagency HIV Study, a multicenter US cohort. METHODS: In this cross-sectional study, ankle-brachial index was estimated using Doppler ultrasound and manual sphygmomanometer in 1899 participants aged more than 40 years with HIV/HCV coinfection, HCV or HIV monoinfection, or neither infection. Multivariable logistic regression was used to estimate the odds of PAD (ankle-brachial index ≤0.9) after controlling for demographic, behavioral, and CVD risk factors. RESULTS: Over two-thirds were African-American, median age was 50 years, and PAD prevalence was 7.7% with little difference by infection status. After multivariable adjustment, neither HIV nor HCV infection was associated with greater odds of PAD. Factors associated with PAD included older age [adjusted odds ratio (aOR): 2.01 for age 61-70 vs. 40-50 years; 95% confidence interval (CI): 1.04, 3.87], Black race (aOR: 2.30; 95% CI: 1.15, 4.63), smoking (aOR: 1.27 per 10-pack-year increment; 95% CI: 1.09, 1.48), and higher SBP (aOR: 1.14 per 10âmmHg; 95% CI: 1.01, 1.28). CONCLUSION: The high PAD prevalence in this nationally representative cohort of women with or at risk for HIV is on par with general population studies in individuals a decade older than our study's median age. HIV and HCV infection are not associated with greater PAD risk relative to uninfected women with similar risk factors. Modifiable traditional CVD risk factors may be important early intervention targets in women with and at risk for HIV.
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Coinfecção/complicações , Infecções por HIV/complicações , Hepatite C/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Índice Tornozelo-Braço , Coinfecção/virologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Prospectivos , Fatores de Risco , Esfigmomanômetros , Ultrassonografia Doppler , Estados Unidos/epidemiologiaAssuntos
Artefatos , Flutter Atrial/diagnóstico , Hipotensão/complicações , Taquicardia/complicações , Flutter Atrial/etiologia , Flutter Atrial/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Taquicardia/fisiopatologiaRESUMO
BACKGROUND: Recent indicators point to substantial increases in the number of young heroin users across much of the United States as well as across Washington State. This study characterizes this younger generation of heroin injectors in order to inform public health responses. METHODS: A cross-sectional analysis was conducted using street-intercept surveys at King County, WA syringe exchange programs in 2013. Survey responses were restricted to heroin injectors (n=389) and then categorized by the participant's age (<30 and ≥30) for a descriptive epidemiological analysis. A manual stepwise logistic regression tested the independent relationship of user characteristics with being under the age of 30. RESULTS: In regression analyses, adjusting for other characteristics, young adults were significantly (p<0.05) more likely to: re-use syringes 2-4 times (OR=2.28 compared to those who used a syringe once), share syringes (OR=2.92), report they were "hooked on" prescription-type opioids prior to using heroin (OR=2.54), have had a sexual partner in the prior year (opposite sex OR=7.37, same sex OR=23.29, both genders OR=22.04), and report powder cocaine use in the prior 3 months (OR=2.49) compared to those ages 30 and older. Young adults were significantly less likely to report using pain medicines (OR=0.33), having an abscess in the prior year (OR=0.33) or having tested positive for hepatitis C (OR=0.22) than older adults adjusting for other variables. CONCLUSIONS: Younger heroin injectors engage in risky injection practices more than older heroin injectors. Along with other significant differences, these findings have implications for outreach programs and medical care for younger heroin injectors.
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Comportamentos Relacionados com a Saúde , Dependência de Heroína/diagnóstico , Dependência de Heroína/epidemiologia , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Estudos de Coortes , Estudos Transversais , Feminino , Dependência de Heroína/psicologia , Humanos , Masculino , Programas de Troca de Agulhas , Autorrelato , Abuso de Substâncias por Via Intravenosa/psicologia , Inquéritos e Questionários , Seringas , Washington/epidemiologia , Adulto JovemRESUMO
Waves of spontaneous electrical activity propagate across many regions of the central nervous system during specific stages of early development. The patterns of wave propagation are critical in the activation of many activity-dependent developmental programs. It is not known how the mechanisms that initiate and propagate spontaneous waves operate during periods in which major changes in neuronal structure and function are taking place. We have recently reported that spontaneous waves of activity propagate across the neonatal mouse cerebral cortex and that these waves are initiated at pacemaker sites in the septal nucleus and ventral cortex. Here we show that spontaneous waves occur between embryonic day 18 (E18) and postnatal day 12 (P12), and that during that period they undergo major changes in transmitter dependence and propagation patterns. At early stages, spontaneous waves are largely GABA dependent and are mostly confined to the septum and ventral cortex. As development proceeds, wave initiation depends increasingly on AMPA-type glutamate receptors, and an ever increasing fraction of waves propagate into the dorsal cortex. The initiation sites and restricted propagation of waves at early stages are highly correlated with the position of GABAergic neurons in the cortex. The later switch to a glutamate-based mechanism allows propagation of waves into the dorsal cortex, and appears to be a compensatory mechanism that ensures continued wave generation even as GABA transmission becomes inhibitory.
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Ondas Encefálicas/fisiologia , Córtex Cerebral/fisiologia , Neurotransmissores/fisiologia , Potenciais de Ação/fisiologia , Animais , Animais Recém-Nascidos , Células Cultivadas , Córtex Cerebral/crescimento & desenvolvimento , Feminino , Ácido Glutâmico/fisiologia , Camundongos , Camundongos Endogâmicos , Neurônios/fisiologia , Ácido gama-Aminobutírico/fisiologiaRESUMO
Spontaneous waves of activity that propagate across large structures during specific developmental stages play central roles in CNS development. To understand the genesis and functions of these waves, it is critical to understand the spatial and temporal patterns of their propagation. We recently reported that spontaneous waves in the neonatal cerebral cortex originate from a ventrolateral pacemaker region. We have now analyzed a large number of spontaneous waves using calcium imaging over the entire area of coronal slices from E18-P1 mouse brains. In all waves, the first cortical region active is this ventrolateral pacemaker. In half of the waves, however, the cortical pacemaker activity is itself triggered by preceding activity in the septal nuclei. Most waves are restricted to the septum and/or ventral cortex, with only some invading the dorsal cortex or the contralateral hemisphere. Waves fail to propagate at very stereotyped locations at the boundary between ventral and dorsal cortex and at the dorsal midline. Waves that cross these boundaries pause at these same locations. Waves at these stages are blocked by both picrotoxin and CNQX, indicating that both GABA(A) and AMPA receptors are involved in spontaneous activity.