Cardiorespiratory Disease Research Articles

Prediction of oxygen requirement in patients with COVID-19 using a pre-trained chest radiograph xAI model: efficient development of auditable risk prediction models via a fine-tuning approach

Risk prediction requires comprehensive integration of clinical information and concurrent radiological findings. We present an upgraded chest radiograph (CXR) explainable artificial intelligence (xAI) model, which was trained on 241,723 well-annotated CXRs obtained prior to the onset of the COVID-19 pandemic. Mean area under the receiver operating characteristic curve (AUROC) for detection of 20 radiographic features was 0.955 (95% CI 0.938–0.955) on PA view and 0.909 (95% CI 0.890–0.925) on AP view. Coexistent and correlated radiographic findings are displayed in an interpretation table, and calibrated classifier confidence is displayed on an AI scoreboard. Retrieval of similar feature patches and comparable CXRs from a Model-Derived Atlas provides justification for model predictions. To demonstrate the feasibility of a fine-tuning approach for efficient and scalable development of xAI risk prediction models, we applied our CXR xAI model, in combination with clinical information, to predict oxygen requirement in COVID-19 patients. Prediction accuracy for high flow oxygen (HFO) and mechanical ventilation (MV) was 0.953 and 0.934 at 24 h and 0.932 and 0.836 at 72 h from the time of emergency department (ED) admission, respectively. Our CXR xAI model is auditable and captures key pathophysiological manifestations of cardiorespiratory diseases and cardiothoracic comorbidities. This model can be efficiently and broadly applied via a fine-tuning approach to provide fully automated risk and outcome predictions in various clinical scenarios in real-world practice.

Frailty and rehabilitation outcome in older patients with cardiorespiratory disease: preliminary multidimensional data.

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with cognitive dysfunctions, psychological distress, poor quality of life (QoL), and functional worsening. In addition, since patients suffering from these conditions are often older adults, frailty syndrome represents a further and important issue to be investigated. The present preliminary study aimed to perform a multidimensional assessment of CHF and/or COPD older patients (age ≥65) undergoing cardiac or pulmonary rehabilitation. The characteristics of the included patients (30 CHF and 30 COPD) resulted almost similar, except for the COPD patients' longer duration of illness and better performances in Addenbrooke's cognitive examination III subtests and short physical performance battery (SPPB). No significant differences were found in the frailty evaluation, but a consistent number of patients resulted to be frail (CHF=36.7% vs COPD=26.6%). After the rehabilitation program, a significant improvement was found in the whole sample concerning the executive functions (14.34±2.49 vs 15.62±2.22, p=0.001), quality of life (58.77±18.87 vs 65.82±18.45, p=0.003), depressive and anxious symptoms (6.27±4.21 vs 3.77±3.39, p=0.001 and 5.17±3.40 vs 3.38±3.21, p=0.001), frailty status [4.00 (3.00,5.00) vs 3.00 (3.00,5.00) p=0.035] and functional exercise abilities [SPPB, 7.40±3.10 vs 9.51±3.67, p=0.0002; timed up and go test, 14.62±4.90 vs 11.97±4.51, p<0.0001; 6-minute walking test, 353.85±127.62 vs 392.59±123.14, p=0.0002]. Preliminary results showed a substantial homogeneity of CHF and COPD older patients' cognitive, psychosocial, frailty, and functional characteristics. Nevertheless, the specific rehabilitation intervention appears promising in both clinical populations. This trial has been registered with the ClinicalTrials.gov, NCT05230927 registration number (clinicaltrials.gov/ct2/show/NCT05230927).

A systematic review and meta-analysis of intraday effects of ambient air pollution and temperature on cardiorespiratory morbidities: First few hours of exposure matters to life.

A growing number of studies have reported an increased risk of cardiovascular disease (CVD) and respiratory disease (RD) within hours after exposure to ambient air pollution or temperature. We assemble published evidence on the sub-daily associations of CVD and RD with ambient air pollution and temperature. Databases of PubMed and Web of Science were searched for original case-crossover and time-series designs of English articles examining the intra-day effects of ambient air pollution [particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10), 2.5-10μm (PM10-2.5), and < 7 μm (SPM), O3, SO2, NO2, CO, and NO] and temperatures (heat and cold) on cardiorespiratory diseases within 24 h after exposure in the general population by comparing with exposure at different exposure levels or periods. Meta-analyses were conducted to pool excess risks (ERs, absolute percentage increase in risk) of CVD and RD morbidities associated with an increase of 10 μg/m3 in particulate matters, 0.1 ppm in CO, and 10 ppb in other gaseous pollutants. Final analysis included thirty-three papers from North America, Europe, Oceania, and Asia. Meta-analysis found an increased risk of total CVD morbidity within 3 h after exposure to PM2.5 [ER%: 2.65% (95% CI: 1.00% to 4.34%)], PM10-2.5 [0.31% (0.02% to 0.59%)], O3 [1.42% (0.14% to 2.73%)], and CO [0.41% (0.01% to 0.81%)]. The risk of total RD morbidity elevated at lag 7-12 h after exposure to PM2.5 [0.69% (0.14% to 1.24%)] and PM10 [0.38% (0.02% to 0.73%)] and at lag 12-24 h after exposure to SO2 [2.68% (0.94% to 4.44%)]. Cause-specific CVD analysis observed an increased risk of myocardial infarction morbidity within 6 h after exposure to PM2.5, PM10, and NO2, and an increased risk of out-of-hospital cardiac arrest morbidity within 12 h after exposure to CO. Risk of total CVD also increased within 24 h after exposure to heat. This study supports a sudden risk increase of cardiorespiratory diseases within a few hours after exposure to air pollution or heat, and some acute and highly lethal diseases such as myocardial infarction and cardiac arrest could be affected within a shorter time. The National Natural Science Foundation of China (Grant No. 42105165; 81773518), the High-level Scientific Research Foundation of Anhui Medical University (Grant No. 0305044201), and the Discipline Construction of Anhui Medical University (Grant No. 0301001836).

Long-term air pollution exposure and Parkinson’s disease mortality in a large pooled European cohort: An ELAPSE study

BackgroundThe link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson’s Disease (PD) remains limited. ObjectiveWe examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts. MethodsWithin the project ‘Effects of Low-Level Air Pollution: A Study in Europe’ (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders. ResultsOf 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01–1.55), NO2 (1.13; 0.95–1.34 per 10 µg/m3), and BC (1.12; 0.94–1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58–0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95–1.62) or BC (1.28; 0.96–1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5. ConclusionLong-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.

Short-term air pollution exposure and hospital admissions for cardiorespiratory diseases in Brazil: A nationwide time-series study between 2008 and 2018

The established evidence associating air pollution with health is limited to populations from specific regions. Further large-scale studies in several regions worldwide are needed to support the literature to date and encourage national governments to act. Brazil is an example of these regions where little research has been performed on a large scale. To address this gap, we conducted a study looking at the relationship between daily PM2.5, NO2, and O3, and hospital admissions for circulatory and respiratory diseases across Brazil between 2008 and 2018. A time-series analytic approach was applied with a distributed lag modeling framework. We used a generalized conditional quasi-Poisson regression model to estimate relative risks (RRs) of the association of each air pollutant with the hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. Our study population includes 23, 791, 093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. Our findings suggest significant associations of ambient air pollution (PM2.5, NO2, and O3) with respiratory and circulatory hospital admissions in Brazil. The national meta-analysis for the whole population showed that for every increase of PM2.5 by 10 μg/m3, there is a 3.28% (95%CI: 2.61; 3.94) increase in the risk of hospital admission for respiratory diseases. For O3, we found positive associations only for some sub-group analyses by age and sex. For NO2, our findings suggest that a 10 ppb increase in this pollutant, there was a 35.26% (95%CI: 24.07; 46.44) increase in the risk of hospital admission for respiratory diseases. This study may better support policymakers to improve the air quality and public health in Brazil.

Visualization of exhaled breath metabolites reveals distinct diagnostic signatures for acute cardiorespiratory breathlessness.

Acute cardiorespiratory breathlessness accounts for one in eight of all emergency hospitalizations. Early, noninvasive diagnostic testing is a clinical priority that allows rapid triage and treatment. Here, we sought to find and replicate diagnostic breath volatile organic compound (VOC) biomarkers of acute cardiorespiratory disease and understand breath metabolite network enrichment in acute disease, with a view to gaining mechanistic insight of breath biochemical derangements. We collected and analyzed exhaled breath samples from 277 participants presenting acute cardiorespiratory exacerbations and aged-matched healthy volunteers. Topological data analysis phenotypes differentiated acute disease from health and acute cardiorespiratory exacerbation subtypes (acute heart failure, acute asthma, acute chronic obstructive pulmonary disease, and community-acquired pneumonia). A multibiomarker score (101 breath biomarkers) demonstrated good diagnostic sensitivity and specificity (≥80%) in both discovery and replication sets and was associated with all-cause mortality at 2 years. In addition, VOC biomarker scores differentiated metabolic subgroups of cardiorespiratory exacerbation. Louvain clustering of VOCs coupled with metabolite enrichment and similarity assessment revealed highly specific enrichment patterns in all acute disease subgroups, for example, selective enrichment of correlated C5-7 hydrocarbons and C3-5 carbonyls in heart failure and selective depletion of correlated aldehydes in acute asthma. This study identified breath VOCs that differentiate acute cardiorespiratory exacerbations and associated subtypes and metabolic clusters of disease-associated VOCs.

Yoga for Stress Relief in Our Body Life

The state of the mind and that of the body are intimately related. If the mind is relaxed, the muscles in the body will also be relaxed. Stress produces a state of physical and mental tension. Yoga, developed thousands of years ago, is recognized as a form of mind-body medicine. In yoga, physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and oxygen uptake as well as hormone function. In addition, the relaxation induced by meditation helps to stabilize the autonomic nervous system with a tendency towards parasympathetic dominance. Physiological benefits which follow, help yoga practitioners become more resilient to stressful conditions and reduce a variety of important risk factors for various diseases, especially cardio-respiratory diseases.

Personal exposures to fine particulate matter and carbon monoxide in relation to cooking activities in rural Malawi.

Background: Air pollution is a major environmental risk factor for cardiorespiratory disease. Exposures to household air pollution from cooking and other activities, are particularly high in Southern Africa. Following an extended period of participant observation in a village in Malawi, we aimed to assess individuals' exposures to fine particulate matter (PM 2.5) and carbon monoxide (CO) and to investigate the different sources of exposure, including different cooking methods. Methods: Adult residents of a village in Malawi wore personal PM 2.5 and CO monitors for 24-48 hours, sampling every 1 (CO) or 2 minutes (PM 2.5). Subsequent in-person interviews recorded potential exposure details over the time periods. We present means and interquartile ranges for overall exposures and summaries stratified by time and activity (exposure). We employed multivariate regression to further explore these characteristics, and Spearman rank correlation to examine the relationship between paired PM 2.5 and CO exposures. Results : Twenty participants (17 female; median age 40 years, IQR: 37-56) provided 831 hours of paired PM 2.5 and CO data. Concentrations of PM 2.5 during combustion activity, usually cooking, far exceeded background levels (no combustion activity): 97.9μg/m 3 (IQR: 22.9-482.0), vs 7.6μg/m 3, IQR: 2.5-20.6 respectively. Background PM 2.5 concentrations were higher during daytime hours (11.7μg/m 3 [IQR: 5.2-30.0] vs 3.3μg/m 3 at night [IQR: 0.7-8.2]). Highest exposures were influenced by cooking location but associated with charcoal use (for CO) and firewood on a three-stone fire (for PM 2.5). Cooking-related exposures were higher in more ventilated places, such as outside the household or on a walled veranda, than during indoor cooking. Conclusions : The study demonstrates the value of combining personal PM 2.5 exposure data with detailed contextual information for providing deeper insights into pollution sources and influences. The finding of similar/lower exposures during cooking in seemingly less-ventilated places should prompt a re-evaluation of proposed clean air interventions in these settings.

The role of routine pulmonary imaging before hyperbaric oxygen treatment.

Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.

Kernel PLS with AdaBoost ensemble learning for particulate matters forecasting in subway environment

Excessive exposure to hazardous air pollutants remains the leading cause of serious cardio-respiratory disease among commuters. To monitor and improve the air quality in time, soft-sensing techniques in metro systems need to be introduced. Adaptive boosting (AdaBoost), as an ensemble learning method, has greater flexibility and adaptability. Compared with a single conventional model, it has a stronger capability to explain the complex features contained in air quality data. In this study, an improved scheme employs AdaBoost to predict key air quality variables, such as PM2.5, in subway environment. To eliminate the adverse effects of noise interference and the collinearity problem among data variables, kernel latent variables are embedded into the original AdaBoost. The proposed method combines kernel partial least squares with AdaBoost (KPLS-AdaBoost). Root mean square error (RMSE) was used to evaluate the prediction performance of KPLS-AdaBoost. The results demonstrate that KPLS-AdaBoost could achieve better modeling performance, providing a new way to realize real-time monitoring of hazardous air pollutants. More precisely, in terms of PM2.5 in the hall, the RMSE value was optimized by approximately 14.44–31.86% compared with that of AdaBoost, random forest, artificial neural network, PLS, KPLS, and PLS-AdaBoost. For PM2.5 at the platform, RMSE value can be decreased by 13.57–38.51%.

Wildfire exposure and health care use among people who use durable medical equipment in Southern California

Background: Climate change-induced wildfires cause trauma, stress, and injury in affected communities, while exposing 70% of the US population to smoke particulate matter (PM2.5) annually and exacerbating cardiorespiratory disease. Few studies examine wildfire smoke exposure in vulnerable populations, and none evaluate residence near a fire. Methods: We identified 236,732 Kaiser Permanente Southern California members who used electricity-dependent durable medical equipment (DME). DME use is associated with respiratory illness and disability, indicating vulnerability to smoke exposure and difficulty evacuating disaster zones. Daily counts of outpatient, inpatient, and emergency healthcare visits made by DME users from 2016-2020 were linked with daily estimates of wildfire generated PM2.5 by residential ZIP code. We used historical maps to identify ZIPs within 20 km of the the 2018 and 2019 Getty and Woolsey fires. We performed negative binomial regression analyses using direct and lagged effects of wildfire PM2.5 and difference-in-differences analyses to evaluate the association between direct wildfire exposure and health care visit frequency. We adjusted for temperature, temporal effects, non-wildfire PM2.5, and spatial confounders. Results: Residence within 20 km of the Woolsey Fire was associated with fewer outpatient and more inpatient visits (RR = 0.98, 95% CI: 0.78, 0.87, RR = 1.45, 95% CI: 1.01, 2.11), while Getty Fire evacuation exposure was not associated with visit frequency. In contrast, increases in wildfire PM2.5 were associated with small and constant increases in outpatient visits 2-6 days after a change. Wildfire PM2.5 was not associated with frequency of inpatient or emergency visits at any lag. Conclusion: DME users, presumed vulnerable to wildfire smoke exposure, may have sheltered in place during fires or took other precautions. However, the Woolsey Fire (which was 10 times larger than the Getty) may have produced health concerns in those directly affected when evacuation was necessary and sheltering in place impossible.

Impact of residential relocation on environmental exposures in European cohorts: an exposome-wide approach

BACKGROUND AND AIM Residential relocation can cause simultaneous changes in multiple environmental exposures and provides a unique opportunity to examine the health impacts of interventions on the external exposome. However, the likelihood of relocation can be influenced by various individual, household, and neighbourhood characteristics that can also influence health. Including Swedish and Dutch adults (SDPP, AMIGO, mean age 49 years) and children (PIAMA, BAMSE, 0-20 years) cohorts, we investigated the factors associated with relocation and changes in multiple environmental exposures across life stages. METHODS We used uni- and multivariable logistic regression to identify predictors of moving (yes/no) including age, sex, ethnicity, education and chronic cardio-respiratory diseases (asthma, hypertension) at baseline. We then conducted multivariable linear regression to identify predictors of changes in individual exposures (air pollution, green space, blue space, impervious surfaces) among participants who relocated during the first four years of follow-up. RESULTS On average, 7% of the participants relocated each year. Before relocation, movers consistently presented higher levels of air pollution than non-movers. Predictors of moving in adults cohorts included younger age, past and current smoking, lower levels of education, but not sex or pre-existing asthma or hypertension. In children cohorts, moving was associated with higher levels of socioeconomic status and parental education. These characteristics were also associated with moving to greener, less polluted areas. Among movers in adults cohorts, older individuals moved to areas with increased pollution and grey space. However, relocating to areas with higher levels of pollution and less green space was associated with higher education levels in SDPP, and lower education levels in AMIGO. CONCLUSIONS Several individual characteristics including age, smoking and education were associated with residential relocation. Among movers, the predictors of exposure change due to relocation varied across cohorts and life stages. KEYWORDS external exposome; air pollution; built environment, residential relocation

Short-Term Coarse Particulate Exposure and Daily Cardio-Respiratory Hospital Admissions in the Helsinki Capital Region

BACKGROUND AND AIM Short-term exposure to coarse inhalable particles (2.5 µg/m3&amp;#x3e;PMcoarse&amp;#x3c;10 µg/m3) has been suggested to increase the risk of respiratory disease independently of fine particles, but studies present mixed findings which are even less clear for other outcomes. This study aims to assess the relationship between short-term exposure to PMcoarse and total admissions for cardio-pulmonary diseases. METHODS We conducted a seventeen-year (01/2001-12/2017) time-series study of the daily admissions for cardio-respiratory disease in relation to the mean levels of coarse particles. We obtained air pollution data from the Helsinki Region Environmental Services Authority, meteorological data from the Finnish Meteorological Institute, and hospital exit records from the Finnish Institute for Health and Welfare. We modelled the association between particles and cardiorespiratory admissions using log-linked quasi-Poisson regression. Penalised splines were used to adjust for the time-trend and the meteorological variables. These models were also adjusted for the weekday, pollen concentration, and influenza outbreaks. Different lag structures were explored in both single-pollutant and multipollutant models. The multipollutant models were simultaneously adjusted for PM2.5, NO2, and O3. RESULTS The mean(standard deviation) concentration of PMcoarse was 6.6(5.9) (µg/m3), while the mean (standard deviation) daily numbers of cardiovascular and respiratory admissions were 25.9(7.3) and 21.3(7.4), respectively. A 10 µg/m3 increase in the same day PMcoarse was associated with a 1.7% (95% CI, 0.4%—3.1%) and a 1.9% (95% CI, 0.5%—3.4%) excess daily risk of respiratory admissions in the single-pollutant and multipollutant models, respectively; same-day excess cardiovascular admissions risks were 0.6% (95% CI, -0.5%—1.7%) and 0.3% (95% CI, -0.9%—1.4%) in similar models. CONCLUSIONS Short-term exposure to PMcoarse can increase respiratory admission risks independently of co-pollutants but has a less determinate effect on cardiovascular admissions. A guideline framework should be considered for PMcoarse. KEYWORDS Coarse Particles, Cardiovascular Admissions, Respiratory Admissions, Time-Series, Fine Particles

Exercise intervention on cardiorespiratory fitness in rheumatoid arthritis patients with high cardiovascular disease risk: a single-arm pilot study.

In patients with rheumatoid arthritis (RA) with cardiovascular disease risk, it is unknown whether exercises are safe, improve cardiorespiratory fitness and reduce disease-related symptoms and cardiovascular-disease (CVD) risk factors. We aimed to investigate in RA patients with CVD risk: (1) safety of medium to high-intensity aerobic exercises, (2) potential changes of cardiorespiratory fitness and (3) disease activity and CVD risk factors in response to the exercises. Single-arm pilot-exercise intervention study including 26 consecutive patients (21 women) with > 4% 10-year risk of CVD mortality according to the Dutch Systematic Coronary Risk Evaluation. Aerobic exercises consisted of two supervised-sessions and five home-sessions per week for 12weeks. Patients were required to exercise at intensities between 65 and 85% of their maximum heart rate. To assess safety, we recorded exercise related adverse events. Before and after the exercises, cardiorespiratory fitness was assessed with a graded maximal oxygen-uptake exercise test, while disease activity was evaluated via the Disease Activity Score-28 (DAS28) using the erythrocyte segmentation rate (ESR). Resting blood pressure, ESR and total cholesterol were assessed as CVD risk factors. Twenty out of 26 patients performed the 12-week exercises without any adverse events. According to patients, withdrawals were unrelated to the exercises. Exercises increased cardiorespiratory fitness (pre: 15.91 vs. post: 18.15ml.kg-1min-1, p = 0.003) and decreased DAS28 (pre: 2.86 vs. post: 2.47, p = 0.04). No changes were detected in CVD risk factors. A 12-week exercise intervention seems to be safe and improves cardiorespiratory fitness and disease activity in patients with RA with a high risk for cardiovascular diseases. Key Points 1. Rheumatoid arthritis patients with high cardiovascular disease risk were able to perform a maximum exercise test and a 12-week aerobic-based medium-to-high intensity exercise intervention. 2. The exercise intervention improved cardiorespiratory fitness and disease activity in rheumatoid arthritis patients with high cardiovascular disease risk. 3. Cardiorespiratory fitness levels were still low post-exercise intervention (i.e. 18.15 ml.kg-1min-1 compared to the 20.9 ml.kg-1min-1 baseline mean of the RA patients without CVD risk).

The effect of ketamine on Kupffer cell count in Wistar rat (Rattus norvegicus) model of sepsis

Background: Sepsis is a serious health problem and is associated with life-threatening complications, such as liver dysfunction, renal failure as well as cardiorespiratory disease. Kupffer cells are immune cells that contribute to the pathogenesis of liver dysfunction. This study aims to determine the effect of ketamine on the number of Kupffer cells in experimental animal models of sepsis.&#x0D; Methodology: This experimental study used fecal-induced peritonitis (FIP) to create a sepsis model in rats (Rattus norvegicus). Thirty rats were divided into six equal groups, namely the negative control group, which was not treated with FIP (Group K−), the positive control group or the sepsis model with FIP treatment (Group K+), and the treatment group; the sepsis model rats (FIP treatment) given 5 mg of ketamine/kg intraperitoneally once at 0 h (Group A), at 3 h (Group B), 5 h (Group C) after induction of sepsis with FIP, and every 2 h after induction of sepsis with FIP for four hours (Group D). Kupffer cells were counted six hours after FIP induction using a hematology analyzer. Statistical test was carried out using the One-Way ANOVA test using SPSS 18.0 software.&#x0D; Results: The number of Kupffer cells in sepsis groups (K+) was significantly higher (22.60 cell/ml) than in the negative control group (K-) (12.68 cell/ml) (P= 0.01). The administration of ketamine in the sepsis model group significantly decreased the number of Kupffer cells close to normal. The number of Kupffer cells was 12.56 cells/ml in Group A, 12.92 cells/ml in Group B, 9.75 cells/ml in Group C, and 8.50 cells/ml in Group D.&#x0D; Conclusion: The administration of ketamine decreased the number of Kupffer cells in the rat model of sepsis induced by FIP to close to the normal group.&#x0D; Abbreviations: APP - acute-phase protein; FIP - fecal induced peritonitis; ICU - Intensive Care Unit; IL – interleukin; KCs - Kupffer cells; ROS - reactive oxygen species; NO - nitric oxide; SIRS - systemic inflammatory response syndrome; TNF-α - tumor necrosis factor-alpha.&#x0D; Keywords: Immunomodulator; Ketamine; Kupffer cell; Sepsis&#x0D; Citation: Asmoro AA, Jaya W, Wahyudi AN, Laksono RM. The effect of ketamine on Kupffer cell count in Wistar rat (Rattus norvegicus) model of sepsis. Anaesth. pain intensive care 2022;26(4): 445-449.&#x0D; DOI: 10.35975/apic.v26i4.1946&#x0D; Received: April 20, 2022; Reviewed: July 13, 2022; Accepted: July 13, 2022

Feasibility of telepsychology support for patients with advanced cardiorespiratory diseases and their caregivers.

ObjectiveThe aim of this study was to test the feasibility of telepsychology support for patients with severe cardiorespiratory disease and their caregivers. A secondary objective was to explore pre-post relationships between patients' and caregivers' clinical measures.MethodsA telehealth program incorporating telepsychology support, i.e., an “on-demand” phone service with a psychologist, was provided to consecutive cardiorespiratory patients at discharge from inpatient rehabilitation and to their caregivers. At the start and end of the 1-year program, participants were interviewed “face-to-face,” and their anxiety/depression level, patients' quality of life (MRF-28, SF-36, and MQOL), and caregivers' (n = 18) family strain (FSQ) and needs (CNA) were assessed: we analyzed the correlations and evaluated customer satisfaction.ResultsOf 80 eligible individuals, 40 took part in this study: 22 patients (FVC = 39 ± 14%; EF = 39 ± 13%) and 18 caregivers. Eleven (28%, 6 patients and 5 caregivers) requested tele-psychological support, resulting in 51 consultations focused on anxiety, difficulty in patient management, worry about the patient's emotional state, and need for emotional support; 3 participants underwent a tailored psychotherapy program. All participants expressed high satisfaction with the service. At enrolment, anxiety was less evident in patients (73% men) than in caregivers, while depressive symptoms were more evident (6.5 ± 3.1), and correlated with MRF-28 and MQOL. Caregivers' (94% women) FSQ showed a “strongly recommended” need for support; at enrolment, high levels of anxiety/depression were correlated with high FSQ (for both, p < 0.05); depressive symptoms correlated negatively with age (p = 0.025) and positively with emotional needs (p = 0.025); anxiety was positively correlated with education level (p = 0.048). At follow-up, patients' perception of support (n = 13/22) tended to increase (p = 0.089), while caregivers' strain (n = 10/18) tended to decline (to within the “range of attention”). At enrolment, caregivers' anxiety/depression and strain correlated with patients' quality of life (for both; p < 0.05). At follow-up, caregivers' strain correlated with patients' quality of life (p = 0.028) and cognitive performance (p = 0.048).ConclusionTelepsychology support associated with a telehealth service is feasible and satisfying for both participants and psychological management. A suitable support program can benefit both patients and caregivers, particularly those at higher risk of depressive symptoms (younger caregivers) and anxiety (all caregivers).

Anxiety symptoms in patients admitted in medical intensive care unit: A cross-sectional study

Objective: Patients admitted to the medical intensive care unit (MICU) for various medical morbidities are prone to suffer various psychiatric symptoms. Common conditions for which psychiatric consultation is sought are anxiety, delirium, self-harm attempt, and adjustment disorder. Anxiety is a commonly encountered problem and can affect the treatment outcome and compliance. This study was carried out in the MICU of tertiary care hospital to assess the pattern of anxiety symptoms in patients admitted to the MICU. Material and Methods: Sixty patients admitted to MICU were included in the study and assessed using semi-structured pro forma, Hamilton Anxiety Rating Scale (HAM-A), Brief Psychiatric Rating Scale, and Faces Anxiety Scale. Data were statistically analyzed using mean, Chi-square test, t-test, and logistic regression test. Results: The majority of the participants were male, predominantly belonging to the age group of 40–59 years. Most of them had some physical, behavioral, or psychological symptoms of anxiety in a mild form. Although the extent of the anxiety symptoms in most of the patients was mild, a few also reported a moderate level of anxiety. Patients with cardiac and respiratory disorders had higher scores on anxiety rating scales than those with other diagnoses. Male gender, cardiorespiratory disease, and the presence or absence of anxiety had a negative correlation (r = −1.79) whereas gender, disease, and presence of mild or moderate anxiety had no statistical significance. Conclusion: Most of the patients, especially those admitted with cardiac and respiratory disorders, had mild anxiety symptoms. Assessment of anxiety in MICU patients can be an important aspect to prevent or reduce the overall disease burden.

Por que devemos nos preocupar com os bebês a termo internados em uma unidade de terapia intensiva neonatal

ABSTRACT This study aims to analyze why we should care about full-term newborns admitted to a neonatal intensive care unit. This is a documented, descriptive, and retrospective study of 262 full-term newborns. Variables used: newborns’ characteristics; main diagnosis, length of stay, follow-up by a multidisciplinary team; post-discharge referral. Most newborns were boys (52%), had a 5-minute Apgar score of nine, and most newborns and their mothers were white (61.1% and 48.9% respectively). Respiratory dysfunction was the main diagnosis (28.8%). Length of stay was eight days. There was a significant difference regarding length of stay (p=0.013), in which those with cardiorespiratory and other diseases stayed less time compared to those with malformation or maternal diseases. The social service was the most sought (81.2%) service, whereas physical therapy the least sought (18%). Newborns with higher weight were hospitalized for less time. Those that underwent physical therapy had longer stay (p&lt;0.001). Main outcome was hospital discharge (68.7%) and referrals to the Basic Health Unit (57%). This study outcomes indicated newborns with less severe conditions, low number of specific studies for the full-term population, other diagnoses that refer to non-intensive care.

Innovative experimental approach for spatial mapping of source-specific risk contributions of potentially toxic trace elements in PM10

Exposure to potentially toxic trace elements (PTTEs) in inhalable particulate matter (PM10) is associated with an increased risk of developing cardiorespiratory diseases. Therefore, in multi-source polluted urban contexts, a spatially-resolved evaluation of health risks associated with exposure to PTTEs in PM is essential to identify critical risk areas. In this study, a very-low volume device for high spatial resolution sampling and analysis of PM10 was employed in Terni (Central Italy) in a wide and dense network (23 sampling sites, about 1 km between each other) during a 15-month monitoring campaign. The soluble and insoluble fraction of 33 elements in PM10 was analysed through a chemical fractionation procedure that increased the selectivity of the elements as source tracers. Total carcinogenic risk (CR) and non-carcinogenic risk (NCR) for adults and children due to concentrations of PTTEs in PM10 were calculated and quantitative source-specific risk apportionment was carried out by applying Positive Matrix Factorization (PMF) to the spatially-resolved concentrations of the chemically fractionated elements. PMF analysis identified 5 factors: steel plant, biomass burning, brake dust, soil dust and road dust. Steel plant showed the greatest risk contribution. Total CR and NCR, and source-specific risk contributions at the 23 sites were interpolated using the ordinary kriging (OK) method and mapped to geo-reference the health risks of the identified sources in the whole study area. This also allowed risk estimation in areas not directly measured and the assessment of the risk contribution of individual sources at each point of the study area. This innovative experimental approach is an effective tool to localize the health risks of spatially disaggregated sources of PTTEs and it may allow for better planning of control strategies and mitigation measures to reduce airborne pollutant concentrations in urban settings polluted by multiple sources.

Effects of Household Air Pollution (HAP) on Cardiovascular Diseases in Low- and Middle-Income Countries (LMICs): A Systematic Review and Meta-Analysis.

Background: Out of over 3 billion people exposed to household air pollution (HAP), approximately 4 million die prematurely, most from cardiorespiratory diseases. Although many recent studies have reported adverse effects of HAP on cardiovascular outcomes, the findings are inconsistent. Objectives: The primary aim of this systematic review is to critically appraise the published studies and report the pooled summary of the findings on the association between HAP and cardiovascular outcomes, particularly in LMICs. Methods: During this systematic review and meta-analysis, six databases were searched systematically, and the protocol was published in PROSPERO (CRD 42021248800). Only peer-reviewed English-language studies published from 1980 to March 2021 were included. We extracted data for the population ≥ 18 years old. Newcastle–Ottawa Criteria were used to assess the quality of evidence. The heterogeneity and publication bias of the studies was evaluated. A meta-analysis was conducted using a random-effect model to pool the findings from published studies. Results: In sixteen studies totaling 547,463 cases, 319,180 were exposed to HAP. The pooled estimate suggested an overall 13% higher risk of CVDs, and a 21% higher risk of CVD mortality in LMICs among those exposed to HAP. Similarly, the increased risk of stroke and cerebrovascular accidents, heart failure, and hypertension was statistically significant among those exposed to HAP but not with myocardial infarction, IHD, eclampsia/preeclampsia, and carotid intima-media thickness. Conclusions: Our findings suggest exposure to HAP increases the risk of cardiovascular outcomes.