RESUMEN
Albumin-to-globulin ratio (AGR) is a cheap, widely accessible component of common blood work that has been implicated in the prognosis of various cancers. This effect is attributed to the cooperative relationship between albumin reflecting the body's nutritional status and globulin serving as an indicator of immune status. With the high morbidity and mortality associated with gastrointestinal cancer and the increasing necessity for cost-effective health care, research into AGR's potential as an indicator of prognosis is warranted. A database search, including key terms between AGR and gastrointestinal cancer, was performed. Random-effects meta-analysis was completed on extracted hazard ratios with two-sided p-values <0.05 being deemed significant. A total of 8,384 patients with gastrointestinal cancer were included. A low AGR was found to be associated with increased risk for reduced overall survival in cancer of the primary GI tract (HR: 1.82, 1.35-2.45, p < 0.001), esophageal cancer (HR: 1.57, 1.19-2.06, p < 0.001), colon cancer (HR: 3.36, 2.02-5.58, p < 0.001), and colorectal cancer (HR: 2.27, 1.15-4.48, p = 0.02) populations. A low AGR is significantly associated with increased risk for reduced overall survival in primary gastrointestinal cancer. Due to the ease of access and low cost to physicians and patients, incorporation of AGR into clinical evaluation of prognosis in these cancers should prove beneficial to patient outcomes.
RESUMEN
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
RESUMEN
The vulnerable phase (VP) of heart failure (HF) is 30 to 90 days after hospital discharge and is associated with increased rehospitalization and mortality rates. The pathophysiological mechanism that drives the VP is due to the progressive increase in left ventricular filling pressure, which can cause hemodynamic congestion and long-term multiorgan injury. Our team analyzed English-written, peer-reviewed research through PubMed from 2018 to 2022, to gather current information on the VP and generate a multipronged approach toward the assessment and intervention of patients with posthospitalization HF. It is our opinion that a structured approach using remote vital monitoring and risk-stratifying tools will be best to identify patients at risk for decompensatory HF during the VP. Medical management can then be targeted toward these high-risk patients by using an organized multidisciplinary team and a disease management program, which includes remote patient-monitoring systems, addressing social determinants of health, and cardiac rehabilitation, to improve rehospitalization and mortality rates.
