Cardiovascular Disease Burden and Major Adverse Cardiac Events in Young Black Patients: A National Analysis of 2 Cohorts 10 Years Apart (2017 Versus 2007).

Background We aim to compare the burden of cardiovascular disease risk factors and major adverse cardiac events and in-hospital outcomes among young Black patients (aged 18-44 years) hospitalized in 2007 and 2017 using data obtained from the National Inpatient Sample database. Method and Results Comparison of the sociodemographic characteristics, comorbidities, and inpatient outcomes, including major adverse cardiac events (all-cause mortality, acute myocardial infarction, cardiogenic shock, cardiac arrest, ventricular fibrillation/flutter, pulmonary embolism, and coronary intervention), between 2017 and 2007 was performed. Multivariable analyses were performed, controlling for potential covariates. A total of 2 922 743 (mean age, 31 years; 70.3% women) admissions among young Black individuals were studied (1 341 068 in 2007 and 1 581 675 in 2017). The 2017 cohort had a younger population (mean, 30 versus 31 years; P<0.001), more male patients (30.4% versus 28.8%; P<0.001), and patients with higher nonelective admissions (76.8% versus 75%; P<0.001), and showed an increasing burden of traditional cardiometabolic comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, depression, along with notable reductions in alcohol abuse and drug abuse, compared with the 2007 cohort. The adjusted multivariable analysis showed worsening in-hospital outcomes, including major adverse cardiac events (adjusted odds ratio [aOR], 1.21), acute myocardial infarction (aOR, 1.34), cardiogenic shock (aOR, 3.12), atrial fibrillation/flutter (aOR, 1.34), ventricular fibrillation/flutter (aOR, 1.32), cardiac arrest (aOR, 2.55), pulmonary embolism (aOR, 1.89), and stroke (aOR, 1.53). The 2017 cohort showed a decreased rate of percutaneous coronary intervention/coronary artery bypass grafting and all-cause mortality versus the 2007 cohort (P<0.001). Conclusions In conclusion, young Black patients have had an increasing burden of cardiovascular disease risk factors and worsened in-hospital outcomes, including major adverse cardiac events and stroke, in the past decade, although with improved survival odds.

A Systematic Review on the Role of Βeta-Blockers in Reducing Cardiac Arrhythmias in Long QT Syndrome Subtypes 1-3.

Long QT syndrome (LQTS) is one of the most common inherited cardiac channelopathies with a prevalence of 1:2000. The condition can be congenital or acquired with 15 recognized genotypes; the most common subtypes are LQTS 1, 2, and 3 making up to 85%-90% of the cases. LQTS is characterized by delayed ventricular cardiomyocyte repolarization manifesting on the surface electrocardiogram (EKG) by a prolonged corrected QT (QTc) interval. The mainstay of treatment for this condition involves in part or combination medical therapy via ß-blockers as first-line (or other anti-arrhythmic), left cardiac sympathectomy, or implantable cardiac defibrillator placement. Given the high rate of adverse cardiac events (ACE) or sudden cardiac death (SCD) in this population of patients with this disease, this review seeks to highlight the genotype-specific treatment consensus in ß-blocker therapy of the most common subtypes. A database search of PubMed, PMC, and Medline was conducted to ascertain the most recent data in the last five years on the management of LQTS types 1-3 and the role of ß-blockers in reducing ACE in these types. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in the study selection, and selected studies focused on humans, written in the English Language, and within the last five years of LQTS subtypes 1, 2, and 3. Eleven relevant studies were selected after considering inclusion criteria, exclusion criteria, and quality appraisal within the last five years, focusing on ß-blocker selection directed based on the subtypes of LQTS. Two meta-analyses, one cohort study, and eight reviews provided significant data that non-selective ß-blockers unequivocally are of benefit in these LQTS types. Summary of findings suggested nadolol followed by propranolol yields the best results in LQTS 1, while nadolol would yield the best effect in LQTS 2 and 3.

Antigenic Variability a Potential Factor in Assessing Relationship Between Guillain Barré Syndrome and Influenza Vaccine - Up to Date Literature Review.

Guillain-Barré syndrome (GBS) is a possible serious adverse event of the influenza vaccine but it is yet to be proven. The objective of our traditional literature review is to assess the potential relationship between GBS and influenza vaccine. A traditional literature review has been carried out by selecting 26 articles from PubMed published between 2011 and 2020. Twenty-six articles met the selection criteria (eight observational studies, four systematic literature review, three meta-analyses, two case-control, two retrospective cohort, and seven case series). Selected studies were focused on monitoring the safety of influenza vaccines, the relative safety of pandemic and seasonal influenza vaccines, influenza vaccine a potential etiology of GBS, and pathogenesis of post-vaccination GBS. Few studies have shown a higher incidence of GBS with a pandemic influenza vaccine compared to the seasonal influenza vaccine, while several studies have concluded a small increase in the possibility of GBS following any type of influenza vaccine. There were some studies that estimated no association possibly due to the presence of confounding factors such as influenza-like illness, low power of the study, and reporting bias in post-vaccination surveillance programs. GSB should be taken into consideration as one of the less common but serious side effects of the influenza vaccine but it should not adversely affect the acceptance of the influenza vaccination program. Continuous monitoring of influenza vaccine safety should be performed regularly.

Partial Versus Complete Resuscitative Endovascular Balloon Occlusion of the Aorta in Exsanguinating Trauma Patients With Non-Compressible Torso Hemorrhage.

Hemorrhage is a major cause of death globally, yet our options to control the condition have remained limited. The standard intervention for patients suffering from a non-compressible torso hemorrhage (NCTH) typically involves resuscitative thoracotomy (RT) with aortic cross-clamping. Apart from being extraordinarily invasive, the survival rates for this procedure remain low. Over the years, research has surfaced that offers much promise regarding the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in exsanguinating patients. Although this type of procedure is not yet universally recognized as a gold standard, it holds some hope for the development of additional research regarding how we can make use of this advancement to improve survival in trauma patients. Complete REBOA (c-REBOA) has not gained wide acceptance due to the undeniable effects it has on normal physiology, metabolic effects, long-term complications, and mortality. Partial REBOA (p-REBOA) is not yet fully validated by research but could potentially be the answer to our problem. The critical question that we should address at this juncture is as follows: how can we improve the survival of patients with an NCTH in the least invasive way possible, while also reducing the feared complications associated with c-REBOA?

H1N1 Influenza Virus in Patients With Cystic Fibrosis: A Literature Review Examining Both Disease Entities and Their Association in Light of the 2009 Pandemic.

The novel coronavirus (COVID-19) that is challenging the health sector and negatively impacting the global economy takes us back to the 2009 influenza A (H1N1) virus pandemic that brought the world to a standstill. In 2009, H1N1 became a significant health concern for several months. It mainly affected people under the age of 65 hyears who had no prior immunity, including children. Among the high-risk populations were pregnant patients and those with chronic cardiac, pulmonary, or respiratory diseases. These patients were at risk of developing severe pneumonia and respiratory complications. Cystic fibrosis (CF) represents a form of severe chronic lung disease in young adults and is the major fatal hereditary disorder of Caucasians in the United States. An online search of PubMed and Google Scholar was conducted to find relevant literature that explicitly examines patients with CF and H1N1.

Unravelling the Role of HSP70 as the Unexplored Molecular Target in Age-Related Macular Degeneration.

The motive behind writing this paper was to highlight the relationship between heat shock protein 70 (HSP70) and age-related macular degeneration (AMD) to explore the potential role of HSP70 as a molecular target in AMD therapy. We performed a comprehensive literature search in various databases and finally found 43 relevant studies related to our objective. In our research, we found that in AMD, oxidative stress causes increased inflammation and excessive apoptosis due to the accumulation of aberrant proteins in retinal pigment epithelium (RPE) cells. The long-lasting overstimulation of the defence system leads to RPE degeneration and results in visual impairment or vision loss. However, after thorough research, it was found that HSP70's role as an immunomodulator, the guardian of the proteolytic pathway and regulator of apoptosis makes it a potential therapeutic target in AMD.