Congestive Symptoms Research Articles

Therapeutic applications of eucalyptus essential oils.

Eucalyptus essential oils (EEOs) have gained significant attention recently anticipated to their broad range of prospective benefits in various biological applications. They have been proven to have strong antibacterial properties against a variety of bacteria, fungi, and viruses. This makes them valuable in combating infections and supporting overall hygiene. The active compounds present in these oils can help alleviate inflammation, making them valuable in addressing inflammatory conditions such as arthritis, respiratory ailments, and skin disorders. Respiratory health benefits are another prominent aspect of EEOs. Inhalation of these oils can help promote clear airways, relieve congestion, and ease symptoms of respiratory conditions like coughs, colds, and sinusitis. They are often utilized in inhalation therapies and chest rubs. They can be used topically or in massage oils to alleviate muscle and joint pain. Furthermore, these oils have shown potential in supporting wound healing. Their antimicrobial activity helps prevent infection, while their anti-inflammatory and analgesic properties contribute to reducing inflammation and pain associated with wounds. In aromatherapy, EEOs are renowned for their invigorating and uplifting qualities, promoting mental clarity, relaxation, and stress relief. Overall, EEOs hold great promise in biological applications, offering a natural and versatile approach to promote health and well-being. Continued research and exploration of their therapeutic potential will further unveil their benefits and broaden their applications in various fields.

Heart Failure Part 3: Diuretic Management in Older People.

Heart failure is a common condition in the older population. As severity progresses, fluid accumulates resulting in congestive symptoms. Loop diuretics are the cornerstone of managing fluid overload and dosing should target euvolemia and congestive symptoms. Volume status is difficult to assess but signs and symptoms such as dyspnea, orthopnea, edema, and weight changes can be evaluated even without specialized equipment in the outpatient setting. Pharmacists are capable of assessing diuretic response and making recommendations for dosing changes in older heart failure patients.

Tricuspid regurgitation: a contemporary review.

Tricuspid regurgitation (TR), an underrecognized disease, overlooked by clinicians for many years due to its assumed benign nature. Recent epidemiological studies suggest significant TR may be seen in up to 6% of elderly patients. An increase in prevalence is expected due to the higher incidence of various clinical predictors of TR progression. Increasing severity of TR is associated with worse outcomes with a novel morphologic classification providing a more refined prediction of outcomes. Advances in cardiac imaging, particularly echocardiography, are integral to the diagnosis of disease severity which not only includes quantitation of TR, but also an assessment of the right atrium, right ventricle and pulmonary arterial circulation. Once identified and quantified, TR management requires a multi-disciplinary heart team management including structural imagers, heart failure specialists, electrophysiologist, cardiac surgeons and interventionalists. Data to support medical therapies are lacking although guidelines support the management of congestive signs and symptoms, as well as comorbidities such as left heart failure and rhythm management. The risks of surgical interventions are slowly improving, however, transcatheter therapies are now available to treat patients with high surgical risk. This manuscript will provide a state-of-art review of this fast-moving field, including current scientific evidences, but also upcoming perspectives with multiple ongoing clinical studies.

Cost-utility and clinical outcome analysis of surgery or oral corticosteroids treatment in patients with chronic rhinosinusitis with nasal polyps

Background: Surgery and oral corticosteroids are recommended therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) patients who are nonresponsive to intranasal corticosteroid treatment. Objective: This study aimed to compare the effectiveness of these 2 treatments in terms of improving sinus-related symptoms, enhancing quality of life, and economic costs and duration costs. Methods: This prospective study enrolled CRSwNP patients. All participants were instructed to complete the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale, and 36-item short-form (SF-36) questionnaire at baseline and 3 months after treatment. The nasal polyp score (NPS) was assessed via endoscopic examination. Additionally, patients were requested to maintain records of economic direct costs, other indirect costs, and duration costs throughout the 3-month period and to report them during each follow-up visit. Results: A total of 40 patients who underwent surgery or received oral corticosteroids were enrolled in this study. After 3 months of treatment, significant improvements were observed between baseline and 3 months after treatment in the NPS, total SNOT-22 score, and nasal congestion, runny nose, facial pain, olfactory function, and overall symptoms measured. Only headache and sleep order were improved in the surgery group. Both physical functioning and general health, as measured by the SF-36, improved after both treatments, and the role-physical, bodily pain, and social functioning domains of the SF-36 improved only in the surgery group. The changes in the NPS, nasal congestion, runny nose, olfactory function, and sleep disorders in the surgery group were greater than those in the oral corticosteroid group (P values = 0.0003, 0.0092, 0.0258, 0.0284, and 0.0164, respectively). Changes in the total SNOT-22 score and SF-36 subscores were not different between the 2 treatment groups. The direct economic costs and duration costs of surgical treatment were 4.5 times and 17.0 times higher, respectively, than those of oral corticosteroid treatment. Conclusions: Both surgical and oral corticosteroid treatments effectively improved clinical symptoms and quality of life in patients with CRSwNP. Patients who underwent surgery exhibited greater improvements in sinus-related symptoms. Nevertheless, oral corticosteroid treatment presented notable advantages in terms of economic cost and duration cost of disease-related care.

Left ventricular dysfunction, pulmonary congestion, or both and cardiovascular risk after acute myocardial infarction

Abstract Background Patients with acute myocardial infarction (AMI) complicated by left ventricular systolic dysfunction (LVSD), pulmonary congestion, or both are at increased risk for adverse cardiovascular events, including long-term heart failure. The EMPACT-MI trial studied the efficacy and safety of early initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) in this population. We set out to evaluate the contemporary real-world risk associated with AMI presenting with LVSD and/or congestion and the projected impact of implementing early SGLT2i post-MI across the spectrum of risk. Purpose To evaluate the independent risk of presenting with LVSD, congestion, or both in patients with AMI. We will further explore the potential impact of the implementation of early initiation of SGLT2i in real-world clinical practice. Methods We conducted a retrospective population-based cohort study in Ontario, Canada, analyzing AMI hospitalizations from April 2009 to March 2022, emulating the EMPACT-MI trial cohort. Patients that survived to hospital discharge were stratified by baseline presentation with LVSD (defined as LVEF<50%), signs or symptoms of congestion or both and compared with a referent group without either risk factor (none). Exclusion criteria were previously established heart failure, prior SGLT2i use, eGFR < 20 ml/min/1.73m2 or chronic dialysis. The primary outcome was a composite of HF hospitalization or all-cause mortality at 30 days and 1 year. We used a multivariable logistic regression model to report an odds ratio (OR) and 95% confidence intervals (CI) adjusted for clinical risk factors. Results Among 36,837 AMI patients, 3% presented with congestion, 55% with LVSD, 10% with both, and 32% with none. Age/sex-adjusted 30-day event rates for the primary endpoint were 30%, 22%, 57%, and 7%, respectively. The corresponding adjusted ORs were 3.34 (95% CI: 2.05-5.46) for congestion, 3.58 (95% CI: 2.72-4.71) for LVSD, and 7.01 (95% CI: 5.09-9.65) for both, versus the reference group (none) (Figure 1). At year 1, a similar pattern of risk was observed (Figure 2). Based on the results of the EMPACT-MI trial being reported at the ACC conference in April 2024, relative and absolute risk differences in outcomes with implementation of early initiation of SGLT2i post-MI in real-world clinical practice across the spectrum of presentation will be reported. Conclusion Patients presenting with pulmonary congestion and/or LVSD remain at high risk of adverse cardiovascular events following AMI. This high-risk group represents an unmet need with a potential impact for improvement with novel interventions such as SGLT2i.

The Effect of Heart Failure Symptom Clusters on Quality of Life: The Moderating Effect of Self-Care Behaviours.

Although heart failure (HF) symptoms affect patients' quality of life (QoL), improving patients' QoL requires certain self-care behaviours. However, the specific role of self-care behaviours in the relationship between HF symptoms and QoL has not been clarified. To evaluate the status of symptom clusters, self-care behaviours and QoL in HF patients, and to analyse and test the moderating effect of self-care behaviours between symptom clusters and QoL. This study is a cross-sectional study. A total of 320 HF patients who treated in thethree hospitals in Chengdu, China, from December 2022 to July 2023 were selected as the research subjects. The patients were evaluated using The General Information Questionnaire, Memorial Symptom Assessment Scale Heart Failure, Self-Care of Heart Failure Index and Minnesota Living with Heart Failure Questionnaire. The statistical analysis methods were exploratory factor analysis, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. There were five symptom clusters in HF patients: emotional symptom cluster (sadness, anxiety, irritability, feeling nervous), digestive symptom cluster (lack of appetite, dry mouth, weight loss, nausea, abdominal distension), ischemic symptom cluster (dizziness, chest pain, palpitations, fatigue), dyspnoea symptom cluster (difficulty breathing when lying flat, waking up breathless at night, sleep difficulty) and congestion symptom cluster (cough, shortness of breath, oedema). There was a significant correlation between HF symptom group, self-care behaviours and QoL (p < 0.05). Both self-care maintenance (β = -0.262, p < 0.001) and self-care management (β = -0.258, p < 0.001) had a moderating effect between symptom clusters and QoL. There are a variety of symptom clusters in HF patients. Improving the self-care behaviours ability of HF patients is conducive to reducing the impact of HF symptom clusters on QoL. The study used the STROBE checklist for reporting. Medical staff should focus on the impact of HF symptom clusters and self-care behaviours on QoL, and formulate corresponding interventions for HF symptom clusters and self-care behaviours to improve the QoL of patients. The head nurse of the cardiovascular department actively assisted us in collecting questionnaires from HF patients, and all HF patients surveyed participated in this study seriously.

Noninvasive biometric monitoring technologies for patients with heart failure.

Heart failure remains one of the leading causes of mortality and hospitalizations in the US that not only impacts quality of life but also poses a significant public health burden. The majority of affected patients are admitted with signs and symptoms of congestion. Despite the initial enthusiasm, traditional remote monitoring strategies focusing primarily on weight gain failed to improve clinical outcomes. Implantable pulmonary artery pressure sensors provide earlier and actionable data, but most patients would favor forgoing an invasive procedure in favor of an alternative, non-invasive monitoring platform. Several devices utilizing different combinations of multiparameter monitoring to reliably detect congestion have recently been developed and are undergoing testing in the clinical setting. Combining these sensors with the power of artificial intelligence and machine learning has the potential to revolutionize remote patient monitoring and early congestion detection and to facilitate timely interventions by the care team to prevent hospitalization. This manuscript provides an objective review of novel, noninvasive, multiparameter remote monitoring platforms that may be tailored to individual heart failure phenotypes, aiming to improve quality of life and survival.

Twelve-month outcomes following temperature-controlled radiofrequency treatment of the septal swell body for nasal airway obstruction.

Improved nasal airway obstruction (NAO) symptoms were reported at 3 months following temperature-controlled radiofrequency (TCRF) treatment of the septal swell body (SSB). This report provides results from assessments of the long-term safety and efficacy of TCRF treatment of SSB hypertrophy to treat NAO through 12 months posttreatment. This prospective, multicenter, long-term, open-label study was conducted in nine centers within the United States and included patients with severe/extreme NAO attributed to SSB hypertrophy. Outcome measures included assessments of Nasal Obstruction Symptom Evaluation Score (NOSE), Numeric Rating Scale (NRS) ease-of-breathing, patient satisfaction, and adverse events at 6 and 12 months. Of the 70 patients treated, 65 and 62 patients completed the 6- and 12-month follow-up assessments. Compared to baseline, there was a 67.5% decrease in adjusted mean NOSE scores at 6 months (mean change -49.6, 95% confidence interval [CI] -54.8 to -44.4; p<0.001) and a 65.4% decrease at 12 months (mean change -48.1, 95% CI -53.7 to -42.5); p<0.001), which is consistent with previously published 3-month results. A 62.0% and 62.5% improvement compared to baseline was observed in the NRS ease-of-breathing score at 6 and 12 months, respectively (p<0.001). No serious adverse were reported overall and no new device- or procedure-related adverse events were reported in the interval between 3 and 12 months posttreatment. TCRF treatment of SSB hypertrophy has a significant and durable effect on improving the symptoms of NAO and health-related quality of life in patients with symptoms of nasal obstruction and congestion through 12 months postprocedure.

Manajemen Rhinitis Alergi

Allergic rhinitis (AR) is an atopic disease characterized by symptoms of nasal congestion, clear rhinorrhea, sneezing, postnasal drop, and nasal pruritis. The disease affects one in six people and is associated with significant morbidity, loss of productivity, and health care costs. Historically, AR was considered a disease process in the nasal airways only, although it is not serious, allergic rhinitis should be considered as a quite serious condition because it can affect the sufferer's quality of life due to the severity of the symptoms experienced and can also cause various complications. However, the development of integrated airway theory has classified AR as a component of the systemic allergic response, with other related conditions, such as asthma and atopic dermatitis, having an underlying systemic pathology. Even though it is not serious, allergic rhinitis should be considered as a quite serious condition because it can affect the sufferer's quality of life due to the severity of the symptoms experienced and can also cause various complications. In addition to nasal symptoms, patients with AR may also experience allergic conjunctivitis, non-productive cough, Eustachian tube dysfunction, and chronic sinusitis. Once diagnosed, AR can be treated in a variety of ways, with intranasal glucocorticoids being the first line of therapy.

Diuretic Combination Therapy in Acute Heart Failure: An Updated Review.

Loop diuretics are the cornerstone of decongestive therapy in patients presenting with acute heart failure and have been extensively studied in randomized clinical trials. Therefore, in current guidelines, they are the only drug with a class I recommendation to treat signs and symptoms of congestion when present. However, the percentage of patients achieving successful decongestion is suboptimal, and diuretic resistance frequently develops. Patients with a poor response to loop diuretics and those discharged with residual signs of congestion are characterized by a worse prognosis over time. Recently, a renovated interest in different diuretic classes sprouted among heart failure researchers in order to improve decongestion strategies and ameliorate short- and long-term clinical outcomes. Randomized clinical trials investigating associations among diuretic classes and loop diuretics have been performed but yielded variable results. Therefore, despite initial evidence of a possible benefit from some of these compounds, a definite way to approach diuretic resistance via diuretic combination therapy is still missing. The aim of this review is to summarize current clinical evidence on the use of diuretic combination therapy in patients with acute heart failure and to suggest a possible approach to avoid or counteract diuretic resistance.

Adverse events associated with early initiation of Eplerenone in patients hospitalized for acute heart failure

BackgroundThe guidelines recommend the initiation or up-titration of heart failure (HF) treatments following an HF hospitalization; however, concerns about adverse events may limit the use of mineralocorticoid receptor antagonists (MRAs). Patient profiles or disease severity might impact adverse events associated with MRA therapy in acute HF. MethodsThe EARLIER trial included patients with acute HF who were randomized to eplerenone or placebo over 6 months. Adverse events (i.e., worsening renal function [WRF], hyperkalemia, hypotension, and volume depletion/dehydration) were assessed. HF-related outcome included a composite of all-cause mortality, HF re-hospitalization, investigator-reported worsening HF and out-of-hospital diuretic intensification. ResultsIn 297 patients (mean age: 67 ± 13 years; 73% males), adverse events were observed: 44.4% experienced WRF (>20% drop in estimated glomerular filtration rate[eGFR] and/or investigator-reported WRF), 8.4% had hyperkalemia (potassium >5.5 mmol/L and/or investigator-reported hyperkalemia), 27.9% experienced hypotension (systolic blood pressure[SBP] <90 mmHg and/or investigator-reported hypotension), and 16.8% had investigator-reported volume depletion/dehydration. Eplerenone vs. placebo did not elevate the incidence of these events (all-p-values>0.0 5). Multivariable analyses revealed that, irrespective of treatment allocation, older age (>7 5 years), prevalent diabetes, symptomatic congestion, and microalbuminuria were associated with increased risk of WRF. Baseline eGFR<60 ml/min/1.73m2 and SBP < 90 mmHg predicted hyperkalemia and hypotension, respectively, while older patients were more likely to experience volume depletion/dehydration. However, these patient profiles did not alter the benefit of eplerenone on outcomes (HR [9 5%CI] = 0.53 [0.29 to 0.97], P = 0.04; all-p-for-interaction>0.10). ConclusionEplerenone did not increase adverse events compared with placebo in acute HF. Importantly, disease severity and comorbidity burden greatly influence adverse events, but not benefit from eplerenone.

Relationship between Nasal Congestion and Quality of Life of Allergic Rhinitis Patients

Nasal congestion is the most common complaint complained of by allergic rhinitis sufferers. Symptoms of nasal congestion in allergic rhinitis can affect a person's quality of life, resulting in decreased work productivity, academic and social success. Based on previous research, the prevalence of allergic rhinitis is 10 to 30% of the world population, where nasal congestion is the most frequently reported symptom with a prevalence of 60%. The aim of this study was to determine the relationship between nasal congestion and the quality of life of allergic rhinitis sufferers among FK Unissula students. This research is an analytical research with a cross sectional design with sample criteria of Unissula Medical Faculty students Class of 2022 and 2021 who suffer from allergic rhinitis and meet the inclusion and exclusion criteria. The inclusion criteria in this research were students of FK Unissula Class of 2022 and 2021 and were willing to be research subjects. The exclusion criteria in this study were students with anatomical nasal abnormalities and those experiencing chronic rhinosinusitis with or without nasal polyps, deviated septum, adenoid hypertrophy, and neoplasms. There were 50 respondents from FK Unissula students who suffered from allergic rhinitis. It was found that 31 (62%) students had a blocked nose and 19 (38%) students did not experience a blocked nose. The research results showed that the majority of students experienced mild nasal congestion and the quality of life for the majority of students was good. The results of the analysis of the relationship between nasal congestion and the quality of life of allergic rhinitis sufferers using the Spearman test obtained p 0.048 with a correlation coefficient of 0.281. The results of the analysis above showed that there was a significant relationship between nasal congestion and the quality of life of allergic rhinitis sufferers.

The Practical Management of Rhinitis in Athletes.

Exercise-induced rhinitis (EIR) is a poorly understood condition that can have a massive impact within elite sport. This was epitomized in 2019 when British cyclist and Tour de France winner Chris Froome lost control of his bike at 37 mph while wiping his nose, resulting in an admission to intensive care. We aim to produce a comprehensive resource to guide the assessment and management of rhinitis in athletes. Rhinitis is a common condition which can be broadly divided into allergic rhinitis (AR) and non-AR (NAR), a subset of which is known as vasomotor rhinitis. Exercise-induced rhinitis is an important but understudied subcategory of NAR. The pathophysiology of the disease is broadly believed to be an imbalance of the sympathetic and parasympathetic nervous systems, leading to symptoms of watery rhinorrhea, nasal congestion, and paroxysmal sneezing. Up to 50% of people suffer from some degree of EIR, which impedes their nasal breathing and affects performance. The assessment of the athlete with rhinitis requires consideration of both allergic and vasomotor contributions to ensure optimal management is introduced. There is no clear guidance for the management of EIR, with uncertainty regarding the most effective pharmaceuticals and optimizing the timing of treatment to enable peak performance. N/A. N/A. N/A. N/A. Based on expert clinical experience in a busy ear, nose, and throat center and a systematic review of current literature, this article proposes a step-wise, incremental approach to the management of EIR symptoms. In an industry where marginal gains give athletes a competitive edge, optimal management of EIR is crucial.

Diuretic Treatment in Heart Failure: A Practical Guide for Clinicians.

Congestion and fluid retention are the hallmarks of decompensated heart failure and the major reason for the hospitalization of patients with heart failure. Diuretics have been used in heart failure for decades, and they remain the backbone of the contemporary management of heart failure. Loop diuretics is the preferred diuretic, and it has been given a class I recommendation by clinical guidelines for the relief of congestion symptoms. Although loop diuretics have been used virtually among all patients with acute decompensated heart failure, there is still very limited clinical evidence to guide the optimized diuretics use. This is a sharp contrast to the rapidly growing evidence of the rest of the guideline-directed medical therapy of heart failure and calls for further studies. The loop diuretics possess a unique pharmacology and pharmacokinetics that lay the ground for different strategies to increase diuretic efficiency. However, many of these approaches have not been evaluated in randomized clinical trials. In recent years, a stepped and protocolized diuretics dosing has been suggested to have superior benefits over an individual clinician-based strategy. Diuretic resistance has been a major challenge to decongestion therapy for patients with heart failure and is associated with a poor clinical prognosis. Recently, therapy options have emerged to help overcome diuretic resistance to loop diuretics and have been evaluated in randomized clinical trials. In this review, we aim to provide a comprehensive review of the pharmacology and clinical use of loop diuretics in the context of heart failure, with attention to its side effects, and adjuncts, as well as the challenges and future direction.

Lymphatic morphology and function in chronic right heart failure due to secondary tricuspid valve regurgitation

BackgroundIn heart failure, the capacity of the lymphatic system dictates symptoms of circulatory congestion. This study aimed at describing structural and functional changes of the lymphatic system in patients with chronic right-sided heart failure. MethodsIndividuals with long-standing severe tricuspid valve regurgitation and symptoms of heart failure were compared with age- gender- and weight-matched controls. Lymphatic structure and function were examined using non-contrast MR lymphangiography and near-infrared fluorescence imaging. Microvascular fluid dynamics and distribution were evaluated using strain gauge plethysmography and bio-impedance. ResultsIn total nine patients and nine controls were included. Lymphatic morphology was unchanged in cases compared to controls with similar thoracic duct diameters 3.1(2.1–3.5) mm vs. 2.0(1.8–2.4) mm (p-value = 0.11), similar lymphatic classifications (p-value 0.34), and an identical number of lymphatic vessels in the legs 6 ± 1 vs. 6 ± 3 vessels/field (p-value = 0.72). Lymphatic function was comparable with contraction frequencies of 0.5 ± 0.2 and 0.5 ± 0.3 /min (p-value = 0.52) and a maximal lymphatic pumping pressure of 60 ± 13 and 57 ± 12 mmHg (p-value = 0.59) for cases and controls respectively. Finally, microvascular capillary filtration, isovolumetric threshold, and fluid distribution were similar between groups (p-value≥0.16 for all comparisons). ConclusionIn this small exploratory study, individuals with severe secondary tricuspid valve regurgitation and right-sided heart failure displayed a largely similar lymphatic anatomy and function. Thoracic duct diameter displayed a trend towards increased size in the patient group. We speculate that cases were indeed stable and optimally treated at the time of examination, and with a lymphatic system largely unaffected by any of the current or prior hemodynamic changes.

Sequential Blockade with Loop Diuretics and Acetazolamide: A Novel Strategy in Acute Heart Failure

Abstract Acute decompensated heart failure (HF) is the most common form of acute HF (AHF) and presents with systemic congestion due to left ventricular dysfunction with sodium and water retention. Diuretics are the mainstay of treatment for AHF, with loop diuretics being the first-line therapy. However, in some studies, patients who were given high doses of loop diuretics were discharged from the hospital with residual signs of volume overload. Combining acetazolamide, a carbonic anhydrase inhibitor, with loop diuretics has been shown to be beneficial as it increases the efficacy of loop diuretics and reduces the signs and symptoms of congestion. Further, it can be used for the prevention or treatment of diuretic resistance (DR). Sequential nephron blockade with acetazolamide has emerged as a novel strategy for the treatment of AHF to enhance the efficacy of loop diuretics and prevent DR. This review highlights the combination of acetazolamide with loop diuretics as an alternative and possibly more effective decongestive strategy option in AHF patients. Nevertheless, there is limited evidence to support this combination therapy, and further research is necessary to substantiate its use in AHF patients.

Acetazolamide Therapy in Patients with Heart Failure: A Meta analysis

Background: Acute heart failure (AHF) is a sudden worsening of chronic HF necessitating hospitalization. It involves complex pathophysiology including activation of multiple pathways (inflammatory, neurohumoral, immune) in multiple organs leading to unfavorable short and long-term prognosis. Impaired diuretic response caused by sodium reabsorption is associated with increased rehospitalization and mortality. Since a large amount of sodium is reabsorbed in the proximal tubule, acetazolamide induces natriuresis and may facilitate further diuresis. We performed this meta-analysis to assess the effects of acetazolamide therapy on natriuresis and clinical symptoms of congestion including rales and dyspnea. Methods: A literature search was conducted using EMBASE, MEDLINE, and Google Scholar Database from inception through 17th April 2023 to identify studies evaluating the use of acetazolamide in AHF. Search terms included ‘acetazolamide’ and ‘acute heart failure’. Additional relevant articles were evaluated using references of included articles. Eligible studies were randomized clinical trials, published in English, that assessed the effects of addition of acetazolamide to standard diuretic therapy as compared to placebo on natriuresis at 24-48 hours and decongestion. Study quality was assessed by Cochrane risk of bias tool. RevMan 5.4 was used for the analyses. Study results were analyzed using a random effects model. I2 statistics were applied to assess the between-study heterogeneity. Results: Three eligible RCTs of 66 screened studies enrolled a total of 284 heart failure patients who received Acetazolamide in addition to their background diuretics treatment. Of the excluded 63 studies, 33 were reviews, 16 study design was not RCT, two duplicate studies, 6 studies had other outcomes of interest and seven studies compared acetazolamide with other diuretics. Most studies compared acetazolamide with other add on diuretics including spironolactone, metolazone, etc. One study was identified by cross reference and one study Verbrugge et al 2014 that met all the criteria could not be included since it reported natriuretic effects in with standard error without sample size. The results showed that when compared to a placebo, Acetazolamide significantly increased natriuresis at the end of 24 to 48 hours, with a standardized mean difference (SMD) of 0.40 (95% CI, 0.24 to 0.57, p value &lt;0.00001, I2=0). Two of three studies evaluated the effect of addition of Acetazolamide on clinical symptoms of HF, including dyspnea and rales. However, in this 259 patients, addition of Acetazolamide did not demonstrate a significant improvement in dyspnea or rales compared to standard treatment, with an OR of 1.34 (95% CI, 0.37 to 4.91, p = 0.66 I2=70). Cochrane risk of bias showed low risk for two studies and low to moderate for one study with uncertainty in allocation. Conclusions: Our study demonstrates a significant increase in natriuresis but no improvements in clinical symptoms of congestion with use of acetazolamide among HF patients. Multiple strategies to overcome diuretic resistance are being explored to improve in-hospital AHF.

Asymptomatic Children as a Missing Link in Preventing COVID-19 Transmission.

Investigating the prevalence of the coronavirus disease 2019 (COVID-19) infection in asymptomatic children who have been in close contact with symptomatic individuals is instrumental for refining public health approaches, protecting vulnerable populations, and mitigating the broader impact of the pandemic. Accordingly, this study aimed to evaluate the incidence of COVID-19 infection in asymptomatic children who had been in close contact with parents exhibiting COVID-19 symptoms. Study Design: A cross-sectional study. The present cross-sectional study was conducted on 175 asymptomatic children who had been in close contact with COVID-19 confirmed cases in Hamadan County from March 2021 to August 2021. Reverse transcription polymerase chain reaction (RT-PCR) testing was performed on all asymptomatic children who had been in close contact with an individual with COVID-19. Furthermore, multiple logistic regressions were conducted to determine the predictors of COVID-19 transmission from family members to children. Out of the 175 children in close contact with index cases, 53 (30.29%) tested positive for COVID-19 through PCR. Regarding factors related to the index case, male cases (Adjusted odds ratio [AOR]=2.29; 95% confidence interval [CI]: 1.03-5.09, P=0.041), rural dwellers (AOR=3.22; 95% CI: 1.02-10.16, P=0.046), illiterate cases (AOR=8.45; 95% CI: 1.76-40.65, P=0.008), and cases presenting with nasal congestion symptoms (AOR=9.12; 95% CI: 2.22-37.40, P=0.002) were more prone to transmitting the virus to children who had close contact with them. The findings of the present study suggested that asymptomatic COVID-19 infection in household contacts is significant in children who were in close contact with a COVID-19-positive patient. Therefore, it is crucial to continue to monitor this group closely.

The role of tolvaptan add-on therapy in patients with acute heart failure: a systematic review and network meta-analysis.

Several conflicting reviews have concluded that the use of loop diuretics is associated with poorer clinical and safety outcomes. Therefore, this study aimed to investigate the efficacy and safety of tolvaptan as an adjunct to conventional diuretic therapy in patients with acute heart failure (AHF). A comprehensive search was conducted on PubMed, Embase, ProQuest, EBSCO, and Cochrane Library until 24 May 2023 to identify randomized controlled trials that compared the effects of tolvaptan with conventional therapy and placebo in patients with AHF. The quality assessment of the included trials was conducted using the Cochrane risk of bias. A network meta-analysis (NMA) was conducted to examine the dosage effect of tolvaptan. A total of 17 studies with 18 reports, involving 10,039 patients, were selected. The tolvaptan add-on therapy significantly alleviated dyspnea [24 h: RR 1.16 (1.04, 1.29), 48 h: RR 1.18 (1.04, 1.33)], reduced body weight within 48 h [Asian group, MD -0.93 (-1.48, -0.38); non-Asian group, MD -2.76 (-2.88, -2.65)], reduced edema [RR 1.08 (1.02, 1.15)], increased serum sodium [non-Asian group, MD 3.40 (3.02, 3.78)], and resulted in a change in serum creatinine [MD -0.10 (-0.18, -0.01)]. No significant differences were observed in mortality and rehospitalization. The NMA suggested that an intermediate dosage (15 mg/day) might offer the best efficacy in reducing dyspnea within 24 h, reducing edema, increasing serum sodium, and lowering the incidence of worsening renal function (WRF). In conclusion, the meta-analysis showed that tolvaptan contributed to the short-term alleviation of congestive symptoms, elevated sodium levels, and a lower incidence of WRF. However, no significant benefits were observed in long-term symptoms, rehospitalization rates, and mortality. An intermediate dosage of tolvaptan might be considered the optimal choice for various clinical outcomes. https://www.crd.york.ac.uk/, PROSPERO (CRD42023420288).

Using targeted second-generation sequencing technique to guide clinical diagnosis and the effect of medication on the therapeutic effect and prognosis of respiratory tract infection in children: An observational study.

To explore the effect of targeted second-generation sequencing technique to guide clinical diagnosis and medication on the therapeutic effect and prognosis of respiratory tract infection (RTI) in children. During January 2021 to June 2022, 320 children with RTI cured were selected in our hospital as the object of this retrospective study. The control group accepted empirical broad-spectrum antibacterial therapy and the observation group accepted targeted second-generation sequencing technique to guide diagnosis and medication. The therapeutic effect, improvement time of clinical symptom index, laboratory-related index, level of inflammatory factors, incidence of complications, and parents' treatment satisfaction were compared. The observation group was considerably more efficacious (91.25%) versus the controlled group (72.50%). The duration of enhancement of fever, nasal congestion, tonsillar congestion, and cough symptoms was shorter in the observation group (P < .05). Serum levels of iron, IgA, IgG as well as IgM were substantially elevated in the observation group. The levels of IL-4 and IL-10 were markedly reduced in the observation group after treatment. The prevalence of complications was considerably below that of the comparison group (21.25%) in the observation group (8.75%). Parental satisfaction with therapy was markedly higher in the observation group (92.50%) than in the control group (66.25%). The application of targeted second-generation sequencing technology to guide clinical diagnosis and drug use can elevate the RTIs efficacy and prognosis in childhood. Targeted second-generation sequencing can achieve precise treatment, reduce drug resistance of drug-resistant strains, and improve the efficacy. It has high promotion and application value.