Medical Intervention Strategies Research Articles

Soluble guanylate cyclase stimulators and activators: new horizons in the treatment of priapism associated with sickle cell disease.

Priapism, defined as a prolonged and often painful penile erection occurring without sexual stimulation or desire, is a common complication in sickle cell disease (SCD), affecting up to 48% of male patients. This condition presents significant clinical challenges and can lead to erectile dysfunction if not properly managed. Current pharmacological treatments for SCD-related priapism are primarily reactive rather than preventative, highlighting a gap in effective medical intervention strategies. A critical factor in developing priapism is the reduced basal bioavailability of nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) in erectile tissues. New prevention strategies should ideally target the underlying pathophysiology of the disease. Compounds that stimulate and activate soluble guanylate cyclase (sGC) emerge as potential therapeutic candidates since these compounds have the property of inducing cGMP production by sGC. This review explores the potential of sGC stimulators and activators in treating priapism associated with SCD. We discuss the advantages of these agents in the face of the challenging pathophysiology of SCD. Additionally, the review underscores the impact of intravascular hemolysis and oxidative stress on priapism pathophysiology in SCD, areas in which sGC stimulators and activators may also have beneficial therapeutic effects.

Earthquake-Related Lung Diseases; A Bibliometric Analysis of Publications

Aim: Earthquake-related lung diseases (ERLD) can be seen as direct and indirect disaster results. ERLD such as inhalation of dust and particulates from collapsed buildings in earthquakes, aspiration of water and pathogens due to tsunami after earthquakes, pulmonary thromboembolism, infectious respiratory diseases, and chest traumas can develop after earthquakes. The aim of this bibliometric review is to explore the intellectual structure of ERLD publications.
 Material and Methods: A search strategy for databases related to the ERDL area was developed. 334 articles were accessed in the Web of Science database. As a result of the full-text readings, 152 articles remained, and 152 articles were subjected to citation and co-citation analysis with bibliometric software. In addition to this research, methodologies based on cluster analysis were used to examine the intellectual structure of the field.
 Results: When the time period of the publications is examined, it is seen that the first publication was published in 1996. When the top three authors are examined, Yanai shares the ranking with 6 publications, Ueda 6 publications, and Kobayashi 5 publications. Japan, also an earthquake country, is in first place with 50 publications. Three main clusters were identified. These clusters are “chest traumas: types, frequency, and medical intervention strategies," “earthquake preparedness and earthquake response capacity," and "respiratory tract infections and an earthquake."
 Conclusion: In addition to identifying the most influential journals, authors, and countries on earthquakes in the area of ERLD, this research identified the dominant research themes in this field. Our research outlines the area of ERLD, provides an agenda for future research, and contributes to the fact that the relationship between earthquakes and pulmonary diseases is studied more deeply.

Estimate the incubation period of coronavirus 2019 (COVID-19)

COVID-19 is an infectious disease that presents unprecedented challenges to society. Accurately estimating the incubation period of the coronavirus is critical for effective prevention and control. However, the exact incubation period remains unclear, as COVID-19 symptoms can appear in as little as 2 days or as long as 14 days or more after exposure. Accurate estimation requires original chain-of-infection data, which may not be fully available from the original outbreak in Wuhan, China. In this study, we estimated the incubation period of COVID-19 by leveraging well-documented and epidemiologically informative chain-of-infection data collected from 10 regions outside the original Wuhan areas prior to February 10, 2020. We employed a proposed Monte Carlo simulation approach and nonparametric methods to estimate the incubation period of COVID-19. We also utilized manifold learning and related statistical analysis to uncover incubation relationships between different age and gender groups. Our findings revealed that the incubation period of COVID-19 did not follow general distributions such as lognormal, Weibull, or Gamma. Using proposed Monte Carlo simulations and nonparametric bootstrap methods, we estimated the mean and median incubation periods as 5.84 (95% CI, 5.42–6.25 days) and 5.01 days (95% CI 4.00–6.00 days), respectively. We also found that the incubation periods of groups with ages greater than or equal to 40 years and less than 40 years demonstrated a statistically significant difference. The former group had a longer incubation period and a larger variance than the latter, suggesting the need for different quarantine times or medical intervention strategies. Our machine-learning results further demonstrated that the two age groups were linearly separable, consistent with previous statistical analyses. Additionally, our results indicated that the incubation period difference between males and females was not statistically significant.

Current Status of Workplace Violence and Coping Strategies among Home Healthcare and Long-Term Care Workers

<p>本文著重在職場暴力對居家醫療與長期照護從業人員的健康威脅。職場暴力可分為四種類型：第一型為具犯罪意圖之暴力，第二型是「客戶對員工」施加之暴力，第三型是「員工間」發生的暴力，第四型是親密伴侶間的暴力。其中，醫療保健與社會服務業之勞工被認為是職場暴力之高風險族群，其所受到的暴力通常來自患者或患者親屬（第二型職場暴力）。而對於居家醫療與長期照護工作者而言，由於其工作環境與工作性質，於各類型之職場暴力皆有很高的暴露風險。研究顯示，相當比例的居家醫療與長期照護從業人員經歷過第二型職場暴力，其中，居家醫療從業人員的發生率普遍高於長期照護從業人員。然而，由於通報率偏低，學者們認為醫療場域之職場暴力盛行率有被低估的可能性。本文提出對居家醫療與長期照護從業人員有所裨益的職場暴力預防策略，囊括四種面向。首先，健康與安全之教育訓練可以有效促進居家訪視的安全性，包含成立安全及諮詢委員會、提供教育訓練、加強溝通技巧、強化事件通報流程，以及重視事件之後續追蹤等。其次，對於居家訪視進行風險評估有助於改善居家之環境安全，目前已有數種評量工具。其三，防身物品、緊急電話及合宜之應對態度是面對暴力事件時的重要應對技巧。其四，為預防醫療職場暴力，《職業安全衛生法》與《醫療法》也逐年修訂。綜上所述，本文蒐集醫療場域之職場暴力現況，並提供預防及因應策略，以期居家醫療與長期照護從業人員能擁有更友善健康的工作環境。</p> <p> </p><p>Workplace violence (WPV) is a serious occupational threat for healthcare workers (HCWs). WPV can be divided into the following four types: Type I concerning criminal intent, Type II client-on-worker violence, Type III worker-on-worker violence, and Type IV personal relationship (or intimate partner violence). A high level of exposure to WPV has been identified in the healthcare and social work settings where patients form a common source of WPV (more specifically Type II WPV). Of all healthcare professionals, home healthcare workers (HHCWs) and long-term care workers (LTCWs) are particularly vulnerable to WPV due to the unique characteristics and requirements of their services, and home healthcare workers appear to be at a greater risk of experiencing WPV than their long-term care counterparts. Moreover, most scholars are of the opinion that the prevalence of WPV is very likely to be underestimated due to underreporting. Accordingly, the paper proposed four major WPV coping strategies for the two groups of healthcare workers. First, training courses should be planned and implemented to improve communication skills of workers and safeguard their safety during home and long-term care visits. Relevant committees or advisory boards should be established to streamline incident reporting SOP, provide counseling, develop safety manual, and monitor follow-ups of reported incidents. Second, home environment safety should be assessed using one of the several tools that have already been developed. Third, HHCWs and LTCWs should equip themselves with personal defense and protection gadgets and memorize emergency phone numbers for every visit. Fourth, related laws and regulations, notably Occupational Safety and Health Act and Medical Care Act, should be reviewed and amended on a regular basis to better prevent WPV in the home and long-term care settings. In the paper, we comprehensively report the prevalence of medical workplace violence, prevention and intervention strategies for HHCWs and LTCWs to stay safe while working.</p> <p> </p>

Nanotechnology Tools Enabling Biological Discovery.

Over the years, the engineering aspect of nanotechnology has been significantly exploited. Medical intervention strategies have been developed by leveraging existing molecular biology knowledge and combining it with nanotechnology tools to improve outcomes. However, little attention has been paid to harnessing the strengths of nanotechnology as a biological discovery tool. Fundamental understanding of controlling dynamic biological processes at the subcellular level is key to developing personalized therapeutic and diagnostic interventions. Single-cell analyses using intravital microscopy, expansion microscopy, and microfluidic-based platforms have been helping to better understand cell heterogeneity in healthy and diseased cells, a major challenge in oncology. Also, single-cell analysis has revealed critical signaling pathways and biological intracellular components with key biological functions. The physical manipulation enabled by nanotools can allow real-time monitoring of biological changes at a single-cell level by sampling intracellular fluid from the same cell. The formation of intercellular highways by nanotube-like structures has important clinical implications such as metastasis development. The integration of nanomaterials into optical and molecular imaging techniques has rendered valuable morphological, structural, and biological information. Nanoscale imaging unravels mechanisms of temporality by enabling the visualization of nanoscale dynamics never observed or measured between individual cells with standard biological techniques. The exceptional sensitivity of nanozymes, artificial enzymes, make them perfect components of the next-generation mobile diagnostics devices. Here, we highlight these impactful cancer-related biological discoveries enabled by nanotechnology and producing a paradigm shift in cancer research and oncology.

Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.

Elevated Neutrophil to Lymphocyte Ratio is Associated with Worse Outcomes after Carotid Endarterectomy in Asymptomatic Patients

ObjectiveManagement of carotid artery stenosis (CAS) remains controversial and proper patient selection critical. Elevated neutrophil to lymphocyte ratio (NLR) has been associated with poor outcomes after vascular procedures. The effect of NLR on outcomes after carotid endarterectomy (CEA) in asymptomatic and symptomatic patients is assessed. Materials and MethodsA retrospective review was conducted of all patients between 2010 and 2018 with carotid stenosis >70% as defined by CREST 2 criteria. A total of 922 patients were identified, of whom 806 were treated with CEA and 116 non-operatively with best medical therapy (BMT). Of patients undergoing CEA, 401 patients (290 asymptomatic [aCEA], 111 symptomatic [sCEA]) also had an available NLR calculated from a complete blood count with differential. All patients treated with BMT were asymptomatic and had a baseline NLR available. Kaplan-Meier analysis assessed composite ipsilateral stroke or death over 3 years. ResultsIn sCEA group, the 3-year composite stroke/death rates did not differ between NLR < 3.0 (22.9%) vs NLR > 3.0 (38.1%) (P=.10). In aCEA group, patients with a baseline NLR >3.0 had an increased risk of 3-year stroke/death (42.6%) compared to both those with NLR <3.0 (9.3%, P<.0001) and those treated with BMT (23.6%, P=.003). In patients with NLR <3.0, aCEA showed a superior benefit over BMT with regard to stroke or death (9.3% vs. 26.2%, P=.02). However, in patients with NLR >3.0, there was no longer a benefit to prophylactic CEA compared to BMT (42.6% vs. 22.2%, P=.05). Multivariable analysis identified NLR >3.0 (HR, 3.23; 95% CI, 1.93-5.42; P<.001) and congestive heart failure (HR, 2.18; 95% CI, 1.33-3.58; P=.002) as independent risk factors for stroke/death in patients with asymptomatic carotid artery stenosis. ConclusionsNLR >3.0 is associated with an increased risk of late stroke/death after prophylactic CEA for asymptomatic carotid artery stenosis, with benefits not superior to BMT. NLR may be used to help with selecting asymptomatic patients for CEA. The effect of NLR and outcomes in symptomatic patients requires further study. Better understanding of the mechanism(s) for NLR elevation and medical intervention strategies are needed to modulate outcome risk in these patients.

Machine Learning for Causal Inference in Biological Networks: Perspectives of This Challenge.

Most machine learning-based methods predict outcomes rather than understanding causality. Machine learning methods have been proved to be efficient in finding correlations in data, but unskilful to determine causation. This issue severely limits the applicability of machine learning methods to infer the causal relationships between the entities of a biological network, and more in general of any dynamical system, such as medical intervention strategies and clinical outcomes system, that is representable as a network. From the perspective of those who want to use the results of network inference not only to understand the mechanisms underlying the dynamics, but also to understand how the network reacts to external stimuli (e. g. environmental factors, therapeutic treatments), tools that can understand the causal relationships between data are highly demanded. Given the increasing popularity of machine learning techniques in computational biology and the recent literature proposing the use of machine learning techniques for the inference of biological networks, we would like to present the challenges that mathematics and computer science research faces in generalising machine learning to an approach capable of understanding causal relationships, and the prospects that achieving this will open up for the medical application domains of systems biology, the main paradigm of which is precisely network biology at any physical scale.

Does Covid-19 Rupture Theodicy? Theo-philosophical Musings

When Covid-19 first broke out in Wuhan, China, in December 2019, no one suspected it would go beyond an epidemic. Within less than three months it had become a worldwide pandemic. In the first 15 months since it broke out in Wuhan, the disease grew exponentially, manifesting itself in different variants: Alpha (UK); Beta (South Africa); Gamma (Japan and Brazil); and Delta (India). In August 2021, confirmed cases were 204 million people worldwide, with about 4 million people deceased. Although the mortality rate has halted in China and slightly abated in continental Europe, Canada, Asia and South America, due to medical and social intervention strategies, it is steadily climbing in the USA and Africa. The first vaccine was ready only 12 months after the pandemic broke out, making it one of the quickest manufactured vaccines. For those who operate within a theistic framework, an avalanche of existential questions surfaced: Is this the end of the world? If so, does God, the omnipotent, omniscient and loving Divine being, not care about what seems to be the decimation of human beings on Planet Earth? If the Divine being cares, has it lost its power perhaps? Or, if it is still powerful, has it lost its affectivity? This article gives a theo-philosophical exploration of these questions to make “sense” of what seems like God’s silence amid the loud noise of the Corona virus. The article asks whether God could be blamed in what may seem like silence, and argues on the meaning of God’s “silence.” It then constructs a theodicy that dispenses God of any wrongdoing in the current pandemic.

Physical Activity and Fatigue in Children With Intestinal Failure on Parenteral Nutrition.

With improved survival of children with intestinal failure (IF), it is important to examine the impact on long-term physical function, physical activity (PA), and fatigue and identify clinical factors that may be predictive of impairment. Cross-sectional study in children with IF on parenteral nutrition (PN) compared with healthy age- and sex-matched controls (HCs). Assessments included: Paediatric Quality of Life (PedsQL) Physical Function subscale, PedsQL Multi-Dimensional Fatigue Scale, and PA Perceived Benefits and Barriers scale. PA was measured using an accelerometer. Medical data was collected by chart abstraction. Participants included 21 children with IF (14 girls), median age 8.33 (interquartile range [IQR] 6.96-11.04) years and 33 HCs (20 boys), 8.25 (6.67-10.79) years. In those with IF, 13 (62%) were born prematurely with a median of 15 (7.5-24.5) in-patient hospitalizations. There was a significant difference (P = 0.033) in mean steps/day in children with IF (9709 +/- 3975) compared with HCs (13104 +/- 5416), and a correlation between moderate-to-vigorous PA and gestational age (r = 0.642, P = 0.010). Child and parent proxy scores indicate poorer physical function and greater fatigue in the IF group, along with a correlation between greater fatigue (r = -0.538, P = 0.012), poorer physical function (r = -0.0650, P = 0.0001) in children with more hospitalizations. Barriers to PA include "I am tired" and "I am worried about my line." Children with IF present with lower levels of PA and physical function and greater fatigue compared with their peers. Ongoing development of medical and rehabilitation intervention strategies is vital to optimize outcomes.

Trends in the utilization and reimbursement of coronary revascularization in the United States Medicare population from 2010 to 2018.

To determine utilization and reimbursement trends of coronary revascularization procedures in the US Medicare population from 2000 to 2018. US Medicare population is increasing, and coronary revascularization decreased in the 2000s. This is a population-based, cross sectional study of US Medicare beneficiaries from 2010 to 2018. The Centers for Medicare and Medicaid Services' database was queried for revascularization procedures using the coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) current procedural terminology (CPT) codes. Trends in Medicare enrollees, PCIs, CABGs, and physician reimbursements were analyzed. Total utilization and reimbursement decreased for both revascularization procedures. The national CABG and PCI utilization per enrollee has decreased by 40.7% (best fit line: b coefficient, 95% CI; -0.297, -0.358 to -0.235) and 26.4% (best fit line: -0.229, -0.373 to -0.0858), respectively. For CABG, annual Medicare payout per enrollee and physician compensation per procedure has decreased by 49.3% (best fit line: -0.250, -0.315 to -0.185) and 14.5% (best fit line: -11.54, -15.62 to -7.452), respectively, and for PCI, decreased by 53.3% (best fit line: -0.373, -0.560 to -0.186) and 36.6% (best fit line: -34.15, -49.35 to -18.95), respectively. Amongst the states, there was significant variability in procedure utilization, and CABG reimbursement rates but minimal variability in PCI reimbursement rates. Even though the US population has aged, revascularization utilization and reimbursement continue to decline. Advancement in medical intervention strategies, particularly non-surgical management, may account for these trends. Further understanding of these trends will allow health systems to tailor resources to the aging population.

The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis

IntroductionThe impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. ObjectivesThe goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. MethodsA retrospective record review with a control group design was used, with audiological and medical record reviews of all participants’ files over a six-month period. A total of 86 participants (intervention group n=32 and control group n=54) were included. Descriptive and inferential statistics were used to analyze the data. ResultsResults revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78–71.74dB), when compared to the intervention group (33–44.39dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. ConclusionsThe results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures.

Metabolomics in Radiation Biodosimetry: Current Approaches and Advances.

Triage and medical intervention strategies for unanticipated exposure during a radiation incident benefit from the early, rapid and accurate assessment of dose level. Radiation exposure results in complex and persistent molecular and cellular responses that ultimately alter the levels of many biological markers, including the metabolomic phenotype. Metabolomics is an emerging field that promises the determination of radiation exposure by the qualitative and quantitative measurements of small molecules in a biological sample. This review highlights the current role of metabolomics in assessing radiation injury, as well as considerations for the diverse range of bioanalytical and sampling technologies that are being used to detect these changes. The authors also address the influence of the physiological status of an individual, the animal models studied, the technology and analysis employed in interrogating response to the radiation insult, and variables that factor into discovery and development of robust biomarker signatures. Furthermore, available databases for these studies have been reviewed, and existing regulatory guidance for metabolomics are discussed, with the ultimate goal of providing both context for this area of radiation research and the consideration of pathways for continued development.

The impact of medical interventions for reducing ototoxicity during treatment for multi-drug resistant tuberculosis

IntroductionThe impact of medical interventions for reducing ototoxicity requires focus in contexts where safe non-ototoxic alternative drugs are not yet available. ObjectivesThe goal was to investigate the impact of medical intervention strategies for reducing the ototoxic effects of long-term use of aminoglycosides for the treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in adults at a rural hospital in the Eastern Cape, South Africa. MethodsA retrospective record review with a control group design was used, with audiological and medical record reviews of all participants’ files over a six-month period. A total of 86 participants (intervention group n=32 and control group n=54) were included. Descriptive and inferential statistics were used to analyze the data. ResultsResults revealed progressive hearing loss in both groups, with worsening of thresholds at each subsequent assessment session. The progression of the hearing loss, however, was much slower in the intervention group, with degree of hearing loss being more severe in the control group in the final session of assessment (36.78–71.74dB), when compared to the intervention group (33–44.39dB). Furthermore, the hearing loss in the intervention group remained in the high frequencies while that in the control group progressed to involve the lower frequencies on the audiogram. The most common medical intervention strategies employed in the current study were to reduce the dosage of the ototoxic drug (61%), with the daily dosage reduced to 800mg in 39% of participants, while the administration of the drug was reduced from daily to thrice weekly in 22% of participants. ConclusionsThe results reveal better hearing sensitivity over the treatment period in the intervention group when compared to the control group; thus suggesting that early medical strategies implemented had a significant preventive impact. Current findings are relevant to the audiological, medical and pharmaceutical fields, particularly within the South African context where resource constraints are a consideration in all treatment measures.

A Case–Control Study of Candidaemia in Very Low Birthweight Infants in a Tertiary Hospital in Johannesburg

Abstract Background: Candidaemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans Candida (NAC) species are increasing in incidence as well as resistance to azoles. Very low birthweight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidaemia. Methods: A retrospective case–control study of candidaemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital between 1 January 2015 and 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidaemia, commonest Candida species, antifungal susceptibility profiles and outcomes (death) were identified. A total of 71 infants with confirmed positive blood cultures for candidaemia from the National Health Laboratory Services database were selected, and each case was allocated 3 controls; the final sample comprised 284 infants. Results: Bacterial sepsis, chronic lung disease, necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidaemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidaemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases, respectively. The difference in death between the two groups was not statistically significant. Conclusions: The study demonstrated an increasing rate of candidaemia, predominance of NAC isolates and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented.

Multiple organ failure caused by poisonous contact with a Lonomia sp caterpillar. Case report

Introduction: Lonomic accidents have become of great interest as they represent a public health problem in rural communities. These accidents are challenging for health personnel given their multiple associated complications, difficult di­agnosis and therapeutic variants.Case presentation: This is the case of a 41-year-old male patient who had contact with a cater­pillar of the genus Lonomia sp. He presented with symptoms of bleeding and subsequent multiple organ failure that resolved with the use of antilonomic serum.Discussion: The patient presented with symp­toms that progressed to multiple organ failure and associated hemorrhagic syndrome due to the difficulties for diagnosis. He required ther­apeutic intervention in a primary care institution with subsequent need for treatment in a more complex center considering the deterioration and non-availability of the antilonomic serum.Conclusions: Based on in-hospital medical intervention strategies, the administration of the lonomic serum and the patient’s follow-up through the system, it was possible to con­firm the improvement of his health condition and discharge him. It is important to stress the knowledge of the health professionals who treat these cases in rural areas and the availability of the serum.

The relationship between diabetic retinopathy and psychosocial functioning: a systematic review.

Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the association remains uncertain. To determine the relationship between DR/DME and psychosocial functioning, the latter an umbrella term used to capture the emotional and social aspects of functioning which may include, for example, depression; depressive disorder; anxiety; vision-specific distress; diabetes-specific distress and emotional and social well-being. PubMed, Embase, Medline and the Cochrane Central register were systematically searched for relevant interventional and observational quantitative studies using standardised criteria. Studies with DR/DME and psychosocial functioning as exposures or outcomes were accepted. Study quality was evaluated using the modified Newcastle-Ottawa scale for observational studies, and the modified Down's and Black checklist for interventional studies. Of 1827 titles initially identified, 42 were included in the systematic review. They comprised of four interventions (one RCT, three non-RCTs) and 38 observational studies (33 cross sectional, five prospective). In studies with DR/DME as the exposure (n = 28), its severity and related vision impairment were consistently associated with poor psychosocial outcomes, mostly higher incidence of depression and depressive symptoms. Baseline depression and depressive symptoms were also associated with greater DR incidence and progression of DR. Medical intervention strategies showed significant improvement in psychosocial outcomes in patients with DR, such as significant improvements in mental health domain scores of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ 25). Severity of DR, DME and associated vision loss are significantly associated with poor psychosocial outcomes. Aspects of depression and its symptoms show a bi-directional association, with increased incidence and progression of DR significant in those with baseline depression or depressive symptoms. Based on these findings, we propose two areas that may benefit from targeted interventions: (1) Prevention of development of poor psychological outcomes by preventing and delaying progression of DR/DME; and (2) Improved detection and management of poor psychological functioning by improving screening tools and multidisciplinary care for patients. Subsequent longitudinal studies can further help establish the underlying relationship between the two measures.

What's new in heart failure therapy 2018?

Even though significant progress has been made over the past 3 decades, heart failure remains one of the leading causes of mortality and morbidity in developed countries and contributes significantly to the economic burden of modern health care systems. Especially in patients with preserved ejection fraction, valid therapeutic options are missing due to a lack of evidence. In face of a very heterogeneous condition with an ongoing debate over aetiology and pathophysiology, clinicians face a challenge in providing optimal care for these patients. Recent data suggest that the optimal treatment of the underlying conditions as well as comorbidities that are associated with heart failure might play an ever increasing role in improving outcomes. This focused review summarizes and reviews current data for the treatment of heart failure with both preserved and reduced ejection fractions based on the latest recommendations covering medical therapy and interventional strategies.

Barriers to cardiovascular disease secondary prevention care in the West Bank, Palestine \u2013 a health professional perspective

BackgroundNon-communicable diseases (NCDs) - including cardiovascular disease (CVD), cancer and diabetes - have become a significant global burden on health. Particularly concerning are CVD rates, causing approximately 18 million deaths worldwide every year. The statistics show that the disease is no longer a predominantly high-income country phenomenon, but affects, increasingly, countries in both developing regions and conflict-affected areas. In the occupied Palestinian territory (oPt), the focus of this article, CVD ranks top of ten NCD killers, accounting for approximately 37.6% of deaths. Key risk factors discerned in primary care settings have been related to both structural determinants (i.e. the Israeli occupation) and individual behavioural factors. Unfortunately, no data are available for secondary care settings in the region and, consequently, little is known about patients and their capacity for risk factor behaviour change to manage their CVD.To begin closing this gap in knowledge, our study provides insight into cardiovascular disease secondary prevention care with the overall aim to enhance the understanding of the complexities of managing NCDs like CVD in conflict-affected settings. Specifically, research was carried out among Palestinian health professionals who specialise in coronary artery disease in the West Bank to elicit their views on (a) how socio-political, health system and individual behavioural factors might hinder patients to change their health behaviour and impact on the provision of healthcare and (b) possible solutions for overcoming identified barriers to behaviour change on societal as well as individual-patient levels within secondary care provision in a context of protracted conflict.MethodsThis study is based on a qualitative approach in order to provide more in-depth information about health beliefs and behaviours, experiences and views of health professionals with regards to CVD secondary care. In total, 12 semi-structured interviews were conducted among doctors providing treatment to patients with CVD in secondary care settings. Interviews focused on health professionals’ perspectives on risk factors and perceived barriers to behaviour change among known CVD patients receiving secondary care. Interviewees were also asked to propose possible actions that could be taken to overcome the identified barriers at both societal and individual patient levels. All interviews were digitally recorded, transcribed and analysed using thematic analysis.ResultsStudy results confirmed our prior theory of the complex entanglement of socio-political, health system and individual-level factors with regards to CVD experience, health-seeking and treatment. Also confirmed was our assumption that it is crucial to understand experts’ definitions and approaches to treatment in order to grasp their visions for appropriate and improved prevention and treatment options. In particular, study participants highlighted how political determinants, notably the detrimental impact of the Israeli occupation, and social determinants, directly and indirectly influence behavioural determinants due to physical and bureaucratic barriers to accessing health facilities, economic hardship and chronic stress. These stressors, in turn, were perceived as having a negative effect on individual behavioural risk factors including smoking, unhealthy diet and an increasingly sedentary lifestyle. Proposed solutions included more focused interventions from the Ministry of Health as well as surveillance, primary prevention and health promotion, and management to positively effect behaviour change in order to address the growing burden of CVD in the region.ConclusionsThe study has highlighted medical professionals’ perceptions of how structural and individual behavioural determinants influence their own and individual patient’s abilities to manage cardiovascular risk factors in a setting affected by chronic conflict. Consequently, we propose that medical and social intervention strategies generally used to address CVD risk, be strategically adapted in order to be useful and effective in contexts of armed conflict. Specifically, we call for a solid understanding of the socio-political context and existing health services as well as health providers’ and patients’ health beliefs and related behaviours when developing future health options aimed at addressing CVD in the region. Moreover, for health provision to be effective as well as sustainable, attention needs to be given above all towards a solution for political change.

관상동맥 내의 나선형 유동이 협착도에 따라 분획 혈류 예비능에 미치는 영향에 관한 수치해석

Swirl flow is often found in proximal coronary arteries, because the aortic valves can induce swirl flows in the coronary artery due to vortex formation. In addition, the curvature and tortuosity of arterial configurations can also produce swirl flows. The present study was performed to investigate fractional flow reserve alterations in a post-stenotic distal part due to the presence of pre-stenotic swirl flow by computational fluid dynamics analysis for virtual stenotic models by quantifying fractional flow reserve(FFR). Simplified stenotic coronary models were divided into those with and without pre-stenotic swirl flow. Various degrees of virtual stenosis were grouped into three grades: mild, moderate, and severe, with degree of stenosis of 0 ~ 40%, 50 ~ 60%, and 70 ~ 90%, respectively. In this study, three-dimensional computational hemodynamic simulations were performed under hyperemic conditions in virtual stenotic coronary models by coupling with a zero-dimensional lumped parameter model. The results showed that the influence of pre-stenotic swirl inflow is dominant on FFR alteration in mild stenosis, whereas stenosis is dominant on FFR alteration in moderate/severe stenosis. The decrease in FFR caused by swirl flow is more significant in mild stenosis than moderate/severe stenosis. Biomechanical modeling is useful for clinicians to provide insight for medical intervention strategies. This hemodynamic-based parameter study could play a critical role in the development of a non-invasive imaging-based strategy-support system for percutaneous transluminal angioplasty in cases of mild/moderate stenosis.