RESUMEN
Background Heart failure (HF) is one of the leading causes of hospitalizations among adults, accounting for high rates of morbidity and mortality in the United States. Myocarditis is a less common etiology of HF, and its outcomes are less well understood. Methods We used the Nationwide Readmissions Database from 2016 to 2019, extracting adult patients with a primary diagnosis of HF who were admitted between January and November of each year studied. We excluded patients with missing data on event time or length of stay. Inpatient outcomes were compared between cases of HF without myocarditis and myocarditis-associated HF (MAHF). Survey procedures were applied. Propensity scores as covariates were used in survey-weighted models to estimate the population average treatment effect on the treated using SAS 9.4. Results We included 4,454,272 HF-related weighted admissions for which 4,605 patients (0.1%) had a concurrent diagnosis of myocarditis. Overall, patients with MAHF, compared with HF without myocarditis, were younger (mean age: 53 years vs. 72 years, p < 0.001) with fewer women (45 vs. 48%), respectively. Patients with MAHF had more inpatient complications including cardiac arrest, cardiogenic shock, and use of mechanical circulatory support ( p < 0.001) despite having fewer comorbidities such as diabetes, hypertension, and renal disease. Patients with MAHF had longer mean lengths of stay (9.2 vs. 5.5 days, p < 0.001). In-hospital mortality during index admission was significantly higher in MAHF at 3.9% compared with 2.8% for HF without myocarditis ( p < 0.001). Myocarditis was a key predictor of inpatient mortality adjusting for risk factors. Conclusion Myocarditis-related HF is associated with increased inpatient mortality, resource utilization, and prolonged hospitalization.
RESUMEN
There is a vital role of B cells in the pathogenesis of Systemic Lupus Erythematosus (SLE). Belimumab (Bel), an inhibitor of B cell activating factor (BAFF), and Rituximab (RTX), a monoclonal antibody targeting Cd20 antigen, have been used to manage systemic lupus. Several randomized controlled trials (RCTs) have evaluated these two agents' clinical efficacy and safety in different manifestations of SLE. This study aims to review the randomized control trials involving these two agents systematically and to explain if any disparity is noticed in the primary and secondary outcomes between these two agents. This study is done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After applying the inclusion criteria and quality assessment by independent reviewers and co-authors, relevant papers were identified, and data were extracted. The results have shown that RCTs involving Belimumab achieved primary endpoints; however, targeted endpoints were not achieved in studies involving Rituximab. It is concluded that despite the conflicting results obtained in clinical trials, both are effective in systemic lupus, as indicated in real-world clinical experience. However, better-designed multicenter studies evaluating these B-cell-targeting drugs are needed.
RESUMEN
Psychiatry is one of the many medical subspecialties that have benefited from the advent of telemedicine. Substance abuse treatment via telepsychiatry expeditiously increased with the start of the pandemic and has brought changes to its rules and regulations. In this study, we focused on the prognosis of substance abuse patients treated with telepsychiatry, the various changes that occurred during the pandemic, and the difficulties faced by clinicians using telepsychiatry. PubMed and Google Scholar were searched for relevant articles between January 2010 and July 2022 using both broad and narrow keywords in addition to the MeSH (Medical Subject Heading) approach. The total number of records found was 765. Strict criteria for inclusion and exclusion ensured that only relevant information was collected. After removing duplicates, irrelevant studies, and research that did not meet the inclusion criteria, we were left with 373 studies from both electronic databases. From those, we ultimately retrieved 35 studies, which were subjected to a thorough content search and quality evaluation with the help of specialized instruments, and a total of 19 papers were included in our systematic review. We concluded that telepsychiatry use for substance abuse patients increased during the pandemic, and the prognosis of these patients treated with telepsychiatry was similar to that of in-person treatment. However, a combination of telepsychiatry with in-person sessions showed much better results.
RESUMEN
Diabetes is one of the most well-known and well-researched non-communicable diseases known to humankind. The goal of this article is to show that the prevalence of diabetes is constantly increasing among indigenous people, a major population subgroup in Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this systematic review, and the databases used were PubMed and Google Scholar. Studies that were published in the last 15 years (2007-2022) were selected for this review, and after applying the inclusion and exclusion criteria, screening, and removing duplicates, 10 articles were selected for the final review - three qualitative studies, three observational studies, and four studies without a specified methodology. We used the JBI (Joanna Briggs Institute) checklist, NOS (Newcastle-Ottawa Scale) checklist, and SANRA (Scale for the Assessment of Narrative Review) checklist for quality assessment. We found that all the articles showed that the prevalence of diabetes is increasing in all the Aboriginal communities despite all the interventional programs already in place. Rigorous health plans, health education, and wellness clinics for primary prevention can all be effective in reducing the potential risks of diabetes. More studies exploring the prevalence, effects, and outcomes of diabetes in the indigenous population of Canada are needed to effectively understand the disease and its complications in this group.
RESUMEN
Postmenopausal osteoporosis is a chronic condition with decreased bone mass and altered bone structure, leading to a greater risk of fractures among older women. Exercise has been proposed as a potentially effective non-pharmacological method to prevent this condition. In this systematic review, we investigate the effects and safety of high-impact and high-intensity exercises in improving bone density at popular sites of fragility fractures, namely, the hip and spine. This review also highlights the mechanism of these exercises in improving bone density and other aspects of bone health in postmenopausal women. This study is done adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After applying the eligibility criteria, we selected 10 articles from PubMed and Google Scholar to be included in our study. Based on the findings from the studies, we established that high-intensity and high-impact exercises are effective in improving, or at the very least maintaining, bone density in the lumbar spine and femur in postmenopausal women. An exercise protocol including high-intensity resistance exercises and high-impact training is shown to be most effective in improving bone density and other parameters of bone health. These exercises were found to be safe in older women, however, careful supervision is recommended. All limitations considered, high-intensity and high-impact exercises are an effective strategy to enhance bone density, and potentially reduce the burden of fragility as well as compression fractures in postmenopausal women.
RESUMEN
OBJECTIVES: Syria's protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. RESULTS: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, treat, and follow-up. Pre-conflict, TB in Syria was officially reported at 22 per 100 000 population; the official figure for 2017 of 19 per 100 000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. CONCLUSIONS: The control of TB in Syria requires a multipronged, tailored, and pragmatic approach to improve timely diagnosis, increase detection, stop transmission, and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high, and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction.