Perioperative Acute Myocardial Infarction and Ischemia After Noncardiac Surgery: Pathophysiology, Prevention, and Nursing Implications.

Perioperative acute myocardial infarction (AMI) after noncardiac surgery increases the mortality rate of patients who experience it. Depending on the definition of AMI used and the patient population studied, perioperative AMI occurs in 0.01% to 10% of patients. Most instances of perioperative AMI occur within the first two days after surgery, do not present with classic myocardial infarction symptoms, and are the result of myocardial oxygen supply versus oxygen demand mismatch. Older patients; those with preexisting cardiovascular conditions; those undergoing thoracic, upper abdominal, or major vascular procedures; and those who experience perioperative hemodynamic instability are at particular risk. This article provides a clinically based review of the pathophysiology, perioperative risks, treatment options, outcomes, and nursing implications of perioperative AMI and ischemia. It provides evidence to assist perioperative nurses with meeting the physiologic and safety needs of their patients and highlights the evolving scientific understanding and clinical guidelines to promote current practice.

Anesthesia Implications of Patient Use of Electronic Cigarettes.

Electronic cigarettes are essentially electronic nicotine delivery systems (ENDS). Use of ENDS has increased sharply in the United States in recent years, particularly among youth. We reviewed the literature on ENDS use, based on a PubMed search, with a focus on effects that could influence anesthetic and surgical outcomes. We also included a meta-analysis of articles published between 2016 and 2018 reporting injuries from exploding ENDS. These devices deliver nicotine, which is addictive and a cardiac stimulant. The nicotine in ENDS has been linked to increased risk of heart disease and myocardial infarction. Also, ENDS deliver vapors of solvents, flavorings, and other chemicals that can cause chronic and acute respiratory diseases. Furthermore, ENDS use may pose a cancer risk. However, ENDS are somewhat less dangerous than cigarettes and are used as smoking cessation devices. From the literature review, we identified 15 articles reporting injuries from ENDS fires and explosions to 93 patients. Most of these patients were young (mean age = 31.6 years) and male (91%). The most common injury sites were the thigh (62%) and hand (33%). Because the anesthetist will likely encounter increasing numbers of ENDS users in the future, it is important to identify these patients and to understand the risks of ENDS use.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

11-year trends in pregnancy-related health indicators in Maine, 2000-2010.

The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables) and percentages (for categorical variables) were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <$20,000/year remained stagnant. Maternal prepregnancy BMI increased. Average pregnancy weight gain decreased but the number of women whose pregnancy weight gain was within the recommended range was unchanged. The rates of smoking and alcohol consumption (before and during pregnancy) increased. The Caesarean section rate rose and the fraction of infants born premature (<37 wks gestation) or underweight (<2500 gms) remained unchanged. The fraction of infants who were breast-fed increased. These results suggest that, despite some positive trends, Maine faces significant challenges in meeting Healthy People 2020 goals.

A cardiovascular disease risk factor screening program designed to reach rural residents of Maine, USA.

INTRODUCTION: Cardiovascular disease is the leading cause of death in many countries and a particular burden to rural communities. Hypertension and diabetes are risk factors for cardiovascular disease, but screening for them is suboptimal, particularly in rural settings. Thus screening programs targeting rural dwellers may be important. This article reports the findings of a blood pressure (BP) and blood glucose screening program conducted from a mobile van that visited community events including agricultural fairs across Maine, U.S.A. to bring screening to rural Mainers. The study objectives were to determine: (1) if the screening program was successful at reaching rural Mainers; (2) if rural screenees had a different risk of hypertension or diabetes compared with non-rural screenees; and (3) what characteristics of a community event predict that a screening conducted at that event will reach a high fraction of rural residents. METHODS: The van visited events from 2006-2009 conducting voluntary BP and blood glucose screenings. Results were analyzed by the rurality of the town of residence of the screenees, the rurality of location of the screening event, and the type of screening event (agricultural fair vs other). Systolic BP of 140 mmHg or greater or diastolic BP of 90 mmHg or greater was considered to be hypertension, and systolic BP of 120-139 mmHg or diastolic BP 80-89 mmHg as pre-hypertension. Blood glucose of 140-199 mg/dL was considered to be pre-diabetes and blood glucose of 200 mg/dL or greater as diabetes. Rurality was divided into urban, sub-urban, large rural town, and small rural town/ isolated rural based on Rural Urban Commuting Codes (RUCAs), assigned by zip code. Mean BP and blood glucose values were compared across residence rurality categories by ANOVA, the distribution of screening values into normal/ abnormal categories was compared across residence rurality categories by chi2 test, and the impact of type and rurality of location of screening event on the residence of screenees was assessed with analysis by regression with categorical variables. RESULTS: Over 4 years, 2451 Mainers from 254 towns were screened at 42 events located in 28 towns. Seventy-six percent of screenees lived in rural areas and screenees were more likely to live in rural areas compared with all Maine residents (p < 0.001). Rurality of residence impacted hypertension risk (p = 0.001) but not diabetes risk. Screenees from large rural towns had the highest mean systolic BPs and rural-dwellers had higher hypertension or pre-hypertension risk compared with urban/ sub-urban dwellers. Conducting screenings at agricultural fairs (p = 0.003) and in rural areas (p = 0.001) were independent predictors of attracting more rural screenees. CONCLUSIONS: Holding cardiovascular risk factor screenings in locations that are culturally appropriate and geographically convenient for an at-risk population are common approaches; however, their effectiveness is seldom tested. The results show that both the type of event at which the screening is conducted and the rurality of location of that event help attract rural screenees, and that it is possible for a screening program to reach a population significantly more rural than the population of the state and one that has an elevated hypertension risk.

Genome of the host-cell transforming parasite Theileria annulata compared with T. parva.

Theileria annulata and T. parva are closely related protozoan parasites that cause lymphoproliferative diseases of cattle. We sequenced the genome of T. annulata and compared it with that of T. parva to understand the mechanisms underlying transformation and tropism. Despite high conservation of gene sequences and synteny, the analysis reveals unequally expanded gene families and species-specific genes. We also identify divergent families of putative secreted polypeptides that may reduce immune recognition, candidate regulators of host-cell transformation, and a Theileria-specific protein domain [frequently associated in Theileria (FAINT)] present in a large number of secreted proteins.