Acute Disease Conditions Research Articles

Association between COVID-19 severity and relatively high serum adiponectin levels at the time of admission.

At the beginning of 2020, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to epidemics worldwide. Obesity and visceral fat accumulation have been reported to be independent risk factors for severe COVID-19. Several reports have focused on the levels of adipocytokines/adipokines, including adiponectin (APN), which is exclusively secreted from adipocytes, although the importance of these factors in acute disease conditions remains unclear. Therefore, we investigated the relationship between serum adiponectin levels and COVID-19 severity. Patients with COVID-19 who were admitted to Sumitomo Hospital (Osaka, Japan) from May through October 2021 were included. A total of 107 patients were enrolled in this study. We obtained the anthropometric and clinical laboratory data of the patients at the time of admission and examined the associations between various parameters and COVID-19 severity. The mean period from onset to admission was 6.5 ± 2.8 days. We divided the patients into "non-severe" (mild, moderate-I and moderate-II) (n = 80) and "severe" (n = 27) groups. The "severe" patients were significantly older than "non-severe" patients. Additionally, no significant differences were observed in BMI, sex, or the period from onset to admission. The serum adiponectin levels of "severe" patients at the time of admission were significantly greater than those of "non-severe" patients even after adjusting for age, sex, and BMI. These results suggest that the serum APN levels at the time of admission can predict COVID-19 severity. However, further investigations on the changes in APN levels in acute diseases are needed.

Conocimiento ancestral sobre el uso de plantas silvestres medicinales en el tratamiento de enfermedades en alpacas

In the high Andean areas, the main economic activity is alpaca raising, which is affected by various infectious and parasitic diseases. Rural populations often resort to wild plants that have diverse properties and help control various diseases. The objective was to document the uses of wild plants in the control of alpaca diseases in the high Andean areas of the Puno and Arequipa regions. Fifty alpaca-breeding families were interviewed in five localities. Thirty-two species belonging to 16 families were reported, with the Asteraceae and Fabaceae families having the highest number of species. The most frequently treated pathologies were diarrhea, pneumonia, fever and enteric parasitosis. For diarrhea treatment, the most used plants were M. mollis, S. nutansand T. filifolia, for pneumonia were G. prostrataand G. viravira, for enteric parasitosis were B. tricuneataand L. daucifoliaand for the elimination of ectoparasites (lice) was A. compacta. For all diseases, the treatment dose was higher in adults than in neonates and its application is in the rainy season. In acute disease conditions, rural families choice to drugs. Wild plants are a viable and sustainable alternative for the treatment of various diseases in alpacas.

International Union of Basic and Clinical Pharmacology. CXII: Adenosine Receptors: A Further Update.

Our previous International Union of Basic and Clinical Pharmacology report on the nomenclature and classification of adenosine receptors (2011) contained a number of emerging developments with respect to this G protein-coupled receptor subfamily, including protein structure, protein oligomerization, protein diversity, and allosteric modulation by small molecules. Since then, a wealth of new data and results has been added, allowing us to explore novel concepts such as target binding kinetics and biased signaling of adenosine receptors, to examine a multitude of receptor structures and novel ligands, to gauge new pharmacology, and to evaluate clinical trials with adenosine receptor ligands. This review should therefore be considered a further update of our previous reports from 2001 and 2011.Significance StatementAdenosine receptors (ARs) are of continuing interest for future treatment of chronic and acute disease conditions, including inflammatory diseases, neurodegenerative afflictions, and cancer. The design of AR agonists (“biased” or not) and antagonists is largely structure based now, thanks to the tremendous progress in AR structural biology. The A2A- and A2BAR appear to modulate the immune response in tumor biology. Many clinical trials for this indication are ongoing, whereas an A2AAR antagonist (istradefylline) has been approved as an anti-Parkinson agent.

Evaluation of the Immunomodulatory Effect of Mesenchymal Stem Cells on Sepsis-Induced Acute Respiratory Distress Syndrome: A Systematic Review

Introduction Sepsis and acute respiratory distress syndrome are the most important causes of death. Sepsis accounts for 20% of deaths worldwide and is one of the most common causes of acute respiratory distress syndrome (ARDS) with a prevalence of 23%. Sepsis-induced ARDS occurs among 10% of ICU patients. Today, mesenchymal stem cells (MSCs) therapy has been studied as a new treatment in the management of sepsis and as a promising treatment for ARDS. The aim of the present study was to systematically review studies on the use of MSCs for treatment of sepsis and ARDS.Results The results of the search strategy include eight studies: one meta-analysis, three systematic reviews, one clinical trial, one cohort study, one combined cohort study, and a double-blind clinical trial, and one case report with a sample size of animal models from two meta-analyzes, and one systematic review of 1266 and 1326 animal models and 1,085 patients in human studies. The results of most studies indicated a significant relationship between mesenchymal stem cell (MSCs) therapy and reduced mortality of sepsis syndrome and ARDS. The results of systematic studies also supported the efficacy and health of MSCs in the treatment of sepsis and ARDS. Patients tolerated high doses of intravenous or intrathecal therapy.Conclusion Multi-potency MSCs have an extraordinary ability to respond and manage the immune system and have been studied in animal and human studies as an immune regulatory tool in improving acute disease conditions such as sepsis and respiratory distress syndrome. Results of studies showed that these stem cells can be used clinically, but the need for more extensive studies, especially human studies in the future, is still recommended.

Drugs exposures during pregnancy and neonatal risk assessment

Background: Medication use is inevitable in the management of chronic or acute disease conditions during pregnancy. However, obstetric pharmacotherapy is most challenging for healthcare providers as they make effort to balance the benefit and risk of medication use during pregnancy. Objective: To profile medical conditions and medication use during pregnancy, and to assess potential or actual neonatal risks following drug exposure in pregnancy. Methods: The study was carried out in 6 healthcare facilities in Edo State, Nigeria. A total of 2,530 pregnant women attending antenatal clinics (ANC) in the health facilities were recruited and followed-up to delivery. Demographic, clinical, obstetric, and drug information were collected from women during their first encounter with the investigator and these data were updated in subsequent follow-up visits by the women. Data were collected through interviews, review of medical records and ANC cards. At delivery, the clinical information of the neonates was obtained and recorded and neonatal risk assessment undertaken. The prescribed medications were classified as safe, low risk and high risk drugs in pregnancy. Paired sample t-test method was used to copmpared categorical veriables and p-values

Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations.

Although increased weight, and particularly obesity, has been associated with a more severe clinical course of COVID-19 and risk of fatality, the course of the illness can lead to prolonged length of stay. Changes in nutritional status and weight loss during hospitalisation are largely reported in some populations, but still not explored in COVID-19 patients. Considering that patients with COVID-19 show an increased inflammatory response, other signs and symptoms, which can lead to weight and muscle loss, should be monitored. The aim of this article was to establish possible connections between COVID-19, prolonged hospitalisation and muscle wasting, as well as to propose nutritional recommendations for the prevention and treatment of cachexia, through a narrative review. Identification of risk and presence of malnutrition should be an early step in general assessment of all patients, with regard to more at-risk categories including older adults and individuals suffering from chronic and acute disease conditions, such as COVID-19. The deterioration of nutritional status, and consequently cachexia, increases the risk of mortality and needs to be treated with attention as other complications. There is, however, little hard evidence of nutritional approaches in assisting COVID-19 treatment or its management including cachexia.

The Association of Malnutrition and Disease Conditions in Mortality of Pediatric Patients Presenting to a Rural Emergency Department in Uganda.

The main objectives of this study were to determine the effect of concurrent malnutrition on disease condition and the primary outcome of mortality in children younger than 5 years hospitalized after presenting to a rural emergency department (ED) in Uganda and to identify a high-risk patient population who may benefit from acute ED intervention. A retrospective, observational study was performed to examine the effect of any form of malnutrition on the primary disease conditions of lower-respiratory tract infection (LRTI), malaria, and diarrheal illness. This study was conducted via review of a quality assurance database between January 2010 and July 2014. Of 3428 hospitalized children, the mean age (SD) was 19.8 months (13.9 months) and 56% were boys. Children diagnosed with malaria, an LRTI, or diarrheal illness all had a higher rate of mortality with concurrent malnutrition versus those without malnutrition (malaria, 6.2% [3.6-8.8%] vs 2.8% [2.0-3.7%]; P < 0.01; LRTI, 8.7% [5.0-12.4%] vs. 3.7% [2.6-4.9%], P < 0.01; and diarrheal illness, 10.9% [1.9-19.9%] vs 1.7% [0.1-3.4%], P < 0.01). In children with an LRTI or malaria with concurrent malnutrition, they were statistically significantly less likely to have abnormal temperature and heart rate during the ED encounter than those without concurrent malnutrition. Based on these results, children with malnutrition and concurrent diseases with known high morbidity may not present with abnormal vital signs. This may have clinical relevance in patient management to the acute care provider in identifying and triaging children with malnutrition and acute disease conditions.

Delirium Assessment in Older People in Emergency Departments. A Literature Review.

Delirium is a neuropsychiatric syndrome often manifesting in acute disease conditions, and with a greater prevalence in the older generation. Delirium in the Emergency Department (ED) is a highly prevalent problem that typically goes unnoticed by healthcare providers. The onset of a delirium episode in the ED is associated with an increase in morbidity and mortality. Because delirium is a preventable syndrome, these statistics are unacceptable. Emergency Department staff therefore should strive to perform systematic screening in order to detect delirium. Different tools have been developed for the assessment of delirium by healthcare professionals other than psychiatrists or geriatricians. Emergency Departments require delirium assessment scales of high sensitivity and specificity, suited to the characteristics of the Department, since the time available is scarce. In addition, the presence of dementia in the assessment of delirium may induce sensitivity bias. Despite the existence of numerous delirium rating scales, scales taking less than three minutes to complete are recommended. The choice of the tool depends on the characteristics of the ED. The only scale affording high sensitivity and specificity in older people with and without dementia is the Four “A”s Test (4AT); it requires no training on the part of the rater, and can be performed in under two minutes.

SPIONs functionalized with small peptides for binding of lipopolysaccharide, a pathophysiologically relevant microbial product.

Systemic inflammation such as sepsis represents an acute life-threatening condition, to which often no timely remedy can be found. A promising strategy may be to functionalize magnetic nanoparticles with specific peptides, derived from the binding motives of agglutinating salivary proteins, that allow immobilization of pathogens. In this work, superparamagnetic iron oxide nanoparticles with stable polycondensed aminoalkylsilane layer were developed, to which the heterobifunctional linkers N-succinimidyl 3-(2-pyridyldithio)-propanoate (SDPD) and N-succinimidyl bromoacetate (SBA) were bound. These linkers were further chemoselectively reacted with the thiol group of singularly present cysteines of selected peptides. The resulting functional nanoparticles underwent a detailed physicochemical characterization. The biocompatibility of the primarily coated aminoalkylsilane particles was also investigated. To test the pathogen-binding efficacy of the particles, the lipopolysaccharide-immobilization capacity of the peptide-coated particles was compared with free peptides. Here, one particle-bound peptide species succeeded in capturing 90% of the toxin, whereas the degree of immobilization of the toxin with a system that varied in the sequence of the peptide dropped to 35%. With these promising results, we hope to develop extracorporeal magnetic clearance systems for removing pathogens from the human body in order to accelerate diagnosis and alleviate acute disease conditions such as sepsis.

Sarcopenic obesity: Time to meet the challenge

The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.

Factors predicting home storage of medicines in Northern Uganda.

BackgroundMedicines are kept in households Worldwide for first aid, treatment of chronic or acute disease conditions. This promotes inappropriate use of medicines and hence the associated risks. The study explored the factors which predict availability and utilization of medicines in households of Northern Uganda.MethodA cross sectional survey of 892 households was performed from November-to-December 2012. Five data collectors administered the questionnaires, respondents were requested to bring out any medicines present in their households. Demographic characteristics, drug name, quantity, source, formulation, legibility of drug labels and reasons why the medicines were being kept at home was collected. Data was analyzed using STATA 12.0 at 95% level of significance.ResultsOf the households visited, 35.1% (313/892) had drugs. Paracetamol (11.8%), coartem (11.3%), cotrimoxazole (10%), amoxicillin (9.2%) and metronidazole (8.2%) were the major medicines found. Antibacterial drugs were the most commonly (40.1%) kept type of drugs. The medicines present in households were for on-going treatment (48%); ‘leftover’ (30.5%) and anticipated future use (21.6%). Symptoms of malaria (34.1%) were common in households which had drugs. The medicines kept in homes were mainly from the private sector 60.5% (497/821). The rate of home drug storage was higher 85.3% (267/313) amongst the educated individuals. There was high prevalence 76% (238/313) of self-medication among respondents in households which stored drugs. The average number of medicines in each household was 6 ± 5 with majority (68.1%) having between 1–10 drugs. Previous successful treatment (OR: 1.3; 95% CI: 0.95-1.77), regular income (OR: 1.8; 95% CI: 1.2-2.6) and sex (OR: 0.63; 95% CI: 0.5-0.9) predicted storage of medicines in households in northern Uganda.ConclusionOver a third of households in Northern Uganda store medicines with antibacterial agents being the most common. Self-medication is common among individuals in households which keep drugs. Past successful treatment, regular income and sex predict community home drug storage.

English

Pain control in chronic and acute disease conditions such as cancer pain or post-operative pain is often adequate with the help of appropriate pharmacological agent. A&nbsp;comprehensive&nbsp;review of numerous studies conducted to evaluate the efficacy of hydromorphone (OROS) for the management of acute and chronic pain was performed. Data from 17 controlled trials were reviewed, taking into consideration the usefulness of hydromorphone for the management of chronic and acute pain. Heterogeneity of the studies and the small number of patients involved made the conclusion difficult. Overall the studies found that osmotic-controlled released oral delivery system (OROS) hydromorphone that is effective in the management of chronic pain. But comparative studies with other opioid analgesics find little difference in efficacy and side effect profile. OROS hydromorphone is effective in the management of chronic pain, but it&rsquo;s usefulness in acute pain is less conclusive. &nbsp; Key words:&nbsp;Hydromorphone, osmotic-controlled released oral delivery system (OROS), chronic pain, acute pain.

Service learning: integrating student learning and community service.

Health professions education is directly effected by changes in health care service delivery and financing systems. In the United States, as the health care industry increasingly shifts to a market economy, service delivery venues are moving away from acute care facilities and into community-based settings. Additionally, there is increased emphasis on primary prevention programs, often provided in public health settings. For health professions programs that traditionally provide clinical training in hospitals and long-term care facilities, there are unique challenges associated with identifying new venues in order to insure that students are exposed to a wide variety of patients with a range of chronic to acute disease conditions. One set of tools that has demonstrated usefulness during these kinds of transitions is service learning. This teaching methodology emphasizes increased partnership with clinical training sites, extensive orientation to patient populations and community resources, structured reflection and instilling the ethic of service in future health care providers. Although this article describes utilization of service learning in the context of current conditions in the United States, we hope that the principles presented here can be readily adapted in any setting.

Health care characteristics of migrant agricultural workers in three north Florida counties

Farm workers, representing 65% of the migrant work force in the St. Johns River basin agricultural area of north Florida, were questioned in 1973–1974 about their own and their families' health status and about their use of professional health care services and facilities. The facilities available for use by this population included 22 physicians in private practice, two hospitals, three public health clinics, and two health clinics operated for migrants. Most contacts made by the migrant farm workers were with the health care professionals in the public facilities, primarily those in the migrant health clinics. The average number of visits made by migrant farm worker heads of households to a physician each year was 3.5 visits. In 1971, the National Health Survey reported an average of 4.9 physician visits for all U.S. citizens. The major factors that affected utilization were the presence of an acute medical condition and the perception of being in poor health. The factors that generally have been thought of as impediments to seeking health care, such as transportation, the presence of children in the household, and a lack of education, were found to be of little import. The acute disease conditions that were most frequently reported by these migrant workers as the reason for their contacts included respiratory illnesses, digestive system problems, injuries, and musculoskeletal problems. The chronic conditions included heart disease and hypertension, musculoskeletal disorders, digestive system problems, and genitourinary problems. Little use was made of dental services, except for tooth extractions.

A study of intercurrent conditions observed during pregnancy

R E c E N T obstetric literature is fairly replete with studies concerning the effect of certain individual diseases on the course and outcome of pregnancy and also the counter effect of the pregnancy on the disease. This is particularly true with reference to the more common chronic conditions, such as tuberculosis, cardiac disease, and diabetes. A few acute disease conditions such as pneumonia have been simiIarly studied. Information is lacking, however, on the broader subject of accidental complications of pregnancy, in general, although it is obvious that any condition which may attack the nonpregnant woman during her childbearing years is equally as likely to affect her during gestation, An important reason for the difficulty encountered in studies of this sort has been that most groups available for investigation have not been representative of the childbearing population as a whole. Furthermore, a complete picture of their medical as contrasted with their obstetrical care has been lacking.