Physiological Research Articles

Modeling Zinc Absorption in the Adult Population of Colombia: Insights for Nutritional Evaluation and Intervention Strategies.

Zinc is a vital trace element, yet its deficiency is common in various populations. This study addresses the gap in understanding zinc intake and its relationship with key nutritional parameters in a Colombian population. We analyzed data from 12,987 individuals, focusing on the daily intake of zinc, phytate, protein, and calcium, and used the phytate/zinc molar ratio as an input parameter in the Miller et al. (2013) model. This model was employed to estimate the total absorbed zinc (TAZ) and the fractional absorption of zinc (FAZ). Our findings highlight a general trend towards insufficient intake compared to the standards of the Institute of Medicine (IOM) and Colombia, with a significant percentage of the population falling below the estimated average requirement (EAR) and recommended daily allowance (RDA) for zinc, underscoring the need for targeted nutritional strategies. Our study contributes to a broader understanding of zinc nutrition and public health implications in Colombia, providing a basis for future dietary guidelines and health interventions.

Virtopsy concept around the world: Institute-based survey of worldwide forensic postmortem imaging

Introduction: Forensic routine postmortem imaging in excess of photography and conventional X-ray has been pushed since a few years, in some instances under the name ”Virtopsy”. It constitutes a pivotal innovation in forensic medicine as it allows for the non-invasive exploration of the deceased through diverse imaging techniques. This study offers an analysis of a survey with focus on the worldwide adoption and application of postmortem imaging. Our goal is to uncover and understand regional variances in its deployment application. Methods: A survey comprising 18 questions, both closed-ended and open-ended, was designed collaboratively and distributed globally via email and social network. The survey addressed topics such as autopsy rates, imaging modalities, indications for postmortem imaging, personnel involved, evaluation methods, and communication of findings. The survey was initially sent to institutes with published postmortem imaging research, and later, it was distributed through international forensic radiology and radiographer associations. Statistical analysis was conducted to interpret the results. Results: Responses were obtained from 29 countries, representing 6 continents, with a total of 100 participating institutions. European institutions were predominant (69%), followed by Australia (9), North America (8), Asia (7), Africa (6) and South America (1). The majority of institutions reported 100-500 autopsies annually (31). Among the institutes that reported that they perform post mortem imaging (PMI), most listed postmortem computed tomography (PMCT) as modality (89%). The request to perform PMI was issued by institutes of forensic medicine (51%), researchers (42%), police (43%) or public prosecutor’s office (54%). 48% of the respondents stated that an autopsy must always be performed, even if the cause and manner of death can be ascertained by postmortem imaging. radiographers were primarily responsible for technically performing PMCT (65%) whereas physicians were listed in 28%, autopsy technicians in 18%. The majority of the institutions (32%) identified clinical radiologists as the primary individuals responsible for reading, evaluating radiological images, and writing reports. Many respondents (64%) reported that their image readers had attended specialized postmortem imaging courses. Communication of findings typically involved written reports (28%) or a combination of written reports and illustrated images (31%). Membership of survey respondents was indicated in 38% for the International Society of Forensic Radiology and Imaging (ISFRI) and 5% for the International Association of Forensic Radiographers (IAFR). The question was how many of the responders are members of a PMI focused radiological society or work group. 52% (44 out of 85) respondents indicated they were not a member of a postmortem imaging society. The memberships listed are ISFRI (38%), IAFR (5%) and AGFB (Arbeitsgruppe Forensische Bildgebung, 4%). Conclusion: This study provides a global perspective on the utilization of postmortem imaging in forensic medicine, revealing regional variations in practices and technology adoption. It offers insights into the personnel, techniques, and procedures involved in this field in different countries.

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA.MethodologyA randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee’s functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests—the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05.ResultOf the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM − 4.15; TSE − 4.42; KSE − 3.78), during stair ascent (MWM − 3.89; TSE − 4.88; KSE − 3.56) and descent (MWM − 3.78; TSE − 4.05; KSE − 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM − 7.05; TSE − 7.16; KSE − 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05).ConclusionIn this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA.Trial noClinicalTrials.gov = NCT04099017 23/9/2019.

Medication Reconciliation

The Institute of Medicine (IOM) stated that preventable medication errors are the mostcommon type of errors in healthcare. It is of fundamental significance when building a safercare continuum, as it highlights the reason for continuous and more vigilant medicationreconciliation and required effort at all interfaces of care, including community. Without arobust medication reconciliation process, the potential for catastrophic outcomes remains aconstant concern. Prevention of medication errors is essential through strategies that are basedin evidence of medication reconciliation strategies on medication errors in community

Propensity score analysis for health care disparities: a deweighting approach

BackgroundPropensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM’s definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables.MethodsThe present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions.ResultsThe procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES.ConclusionsDeweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.

Same evidence different recommendations: a methodological assessment of transatlantic guidelines for the management of valvular heart disease.

To identify methodological variations leading to varied recommendations between the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) valvular heart disease (VHD) Guidelines, and to suggest foundational steps towards standardizing guideline development. An in-depth analysis was conducted to evaluate the methodologies used in developing the Transatlantic Guidelines for managing VHD. The evaluation was benchmarked against the standards proposed by the Institute of Medicine. Substantial discrepancies were noted in the methodologies utilized in development processes, including writing committee composition, evidence evaluation, conflict of interest management, and voting processes. Furthermore, despite their mutual differences, both methodologies also demonstrate notable deviations from the IOM standards in several essential areas, including literature review and evidence grading. These dual variances likely influenced divergent treatment recommendations. For example, the ESC/EACTS recommends transcatheter edge-to-edge repair (TEER) for patients ineligible for mitral valve surgery, while the ACC/AHA recommends TEER based on anatomy, regardless of surgical risk. ESC/EACTS guidelines recommend a mechanical aortic prosthesis for patients under 60, while ACC/AHA guidelines recommend it for patients under 50. Notably, the ACC/AHA and ESC/EACTS guidelines have differing age cut-offs for surgical over transcatheter aortic valve replacement (<65 and <75 years, respectively). Variations in methodologies for developing CPGs have resulted in different treatment recommendations that may significantly impact global practice patterns. Standardization of essential processes is vital to increase the uniformity and credibility of CPGs, ultimately improving healthcare quality, reducing variability and enhancing trust in modern medicine.

Stefan R. Bornstein: Stress, diabetes, and depression

Professor Stefan Bornstein currently serves as the Chair of Medicine at the University of Dresden, Germany and Transcampus Dean at King's College London, UK. His extensive experience in the United States and Europe has equipped him with unparalleled expertise, particularly in diabetes and endocrinology. Professor Bornstein has authored over 700 publications, garnering more than 100,000 citations with an impressive h-index above 120. His work is frequently featured in journals such as the New England Journal of Medicine, Nature, and Science. Professor Bornstein's contributions extend beyond academia into influential leadership roles, such as founding the first European Transcampus between King's College and the University of Dresden and initiating the German Australian Institute of Translational Medicine. His achievements have earned him numerous awards, including the Order of Merit of Germany (Bundesverdienstkreuz 1. Class), the highest state distinction in Germany, the Medal of Honour of the University of Dresden, and membership in both the European and German Academies of Sciences. In 2023 Professor Stefan Bornstein became a member of the Freedom of the City of London, in recogntion of both his individual contributions and the success of the TransCampus project. Honorary citizenship of London has existed since the 13th century and originally enabled recipients, who were also required to join a Livery company, to carry out their trade in London. Whilst this practical element no longer applies, the City of London has maintained the Freedom as a living tradition. These accolades reflect his exceptional contributions to medical science and education. We are privileged to share Professor Bornstein's answers to the Genomic Press Interview with our readers.

Henry Hun and his family: Three foundational stories in the history of nineteenth-century American neurology, Part I. Thomas Hun (1808–1896): Nineteenth-century patriarch, neurophilosopher, and proto-neurologist

ABSTRACT Thomas Hun (1808–1896)—along with his sons Edward (1842–1880) and Henry (1854–1924)—were prime movers in establishing the clinical practice and academic discipline of neurology in the Hudson River Valley of New York in the ninteenth and early-twentieth centuries. This article outlines the life of the family’s semi-aristocratic patriarch, beginning with Thomas’s unusual educational background and his six-year post-graduate hiatus in Paris of the 1830s, where he came under the influence of P. C. A. Louis (1787–1872). It lays out his subsequent career as professor of the Institutes of Medicine and ultimately as dean of an American medical school that was not situated in a major metropolis. It also will demonstrate how Thomas Hun’s career as a medical practitioner, academician, neurophilosopher, and “proto-neurologist” recapitulates the evolution of clinical and academic neurology in nineteenth-century America.

Molecules secreted by visceral adipocytes in patients with coronary atherosclerosis and insulin resistance

Aim. To study the association of adipocytokine levels with insulin resistance (IR) and stable/unstable plaques in patients with coronary atherosclerosis.Material and methods. This cross-sectional observational study included 109 men aged 38-79 years with class II-III stable angina pectoris without acute coronary syndrome (ACS), with coronary atherosclerosis verified by coronary angiography. Biochemical tests were carried out using the enzymatic method on a Konelab 30i analyzer at the Laboratory of Clinical Biochemical and Hormonal Studies of Internal Diseases of the Research Institute of Internal and Preventive Medicine — branch of the Federal Research Center Institute of Cytology and Genetics. All patients also underwent anthropometric examination.Results. Patients with coronary atherosclerosis and IR had higher levels of GIP by 1,4 times (p=0,005), GLP-1 by 1,7 times (p=0,032), IL-6 by 3,2 times (p=0,017), leptin by 2,3 times (p=0,001) and pancreatic polypeptide (PP) by 1,9 times (p=0,006). In patients with stable plaques and IR, leptin was 2 times higher, and PP was 1,7 times higher, compared to patients without IR. In patients with unstable plaques and IR, leptin and PP levels are 5,1 and 1,7 times higher, respectively, compared to the group of patients without IR. In patients with IR and stable plaques, PYY was 1,5 times higher than in patients with IR and unstable plaques, while the adiponectin level was 1,9 times higher. Logistic regression analysis demonstrated that PP is associated with IR in patients with unstable plaques.Conclusion. Patients with coronary atherosclerosis and IR had higher levels of GIP, GLP-1, IL-6, leptin and PP. Leptin and PP levels are higher in patients with both stable and unstable plaques and IR, and PYY and adiponectin levels are higher in patients with stable plaques and IR compared with patients without IR. PP is associated with IR in patients with unstable plaques.

Methodological proposals for developing trustworthy recommendations of integrative Chinese-Western medicine

BackgroundTo refine the methods of developing clinical practice guidelines (CPGs) for integrative Chinese-Western medicine (ICWM), promoting the formation of trustworthy, implementable recommendations that integrate the strengths of Chinese and Western medicine. MethodsUsing a nominal group technique (NGT) approach, a multidisciplinary expert panel was established. The panel identified key methodological issues in ICWM-CPG development through literature review and iterative discussions, and formulated methodological proposals to address these issues. The final set of proposals was achieved through consensus among the panel members. ResultsThe collaborative effort resulted in the identification of five pivotal methodological issues and the subsequent establishment of 22 specific recommendations. These encompass strict adherence to renowned standards, such as those proposed by the Institute of Medicine (IOM) and Guidelines International Network (G-I-N), the employment of methodologies like the GRADE approach and RIGHT statement, the strategic constitution of a balanced development group, the adept identification of ICWM-focused clinical inquiries, the nuanced integration of diverse evidence sources, and the detailed crafting of transparent, implementable recommendations. ConclusionsThis study concentrates on the most crucial and prevalent methodological issues in ICWM-CPG development, proposing a series of recommendations. These suggestions result from a multidisciplinary expert consensus, aiming to provide methodological guidance for ICWM-CPG developers, building upon the current foundational methodologies.

Low-dose naltrexone for post-COVID fatigue syndrome: a study protocol for a double-blind, randomised trial in British Columbia

IntroductionA significant proportion of individuals suffering from post COVID-19 condition (PCC, also known as long COVID) can present with persistent, disabling fatigue similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and...

Transforming into a Learning Health System: A Quality Improvement Initiative.

The Institute of Medicine introduced the Learning Healthcare System concept in 2006. The system emphasizes quality, safety, and value to improve patient outcomes. The Bellevue Clinic and Surgical Center is an ambulatory surgical center that embraces continuous quality improvement to provide exceptional patient-centered care to the pediatric surgical population. We used statistical process control charts to study the hospital's electronic health record data. Over the past 7 years, we have focused on the following areas: efficiency (surgical block time use), effectiveness (providing adequate analgesia after transitioning to an opioid-sparing protocol), efficacy (creating a pediatric enhanced recovery program), equity (evaluating for racial disparities in surgical readmission rates), and finally, environmental safety (tracking and reducing our facility's greenhouse gas emissions from inhaled anesthetics). We have seen improvement in urology surgery efficiency, resulting in a 37% increase in monthly surgical volume, continued adaptation to our opioid-sparing protocol to further reduce postanesthesia care unit opioid administration for tonsillectomy and adenoidectomy cases, successful implementation of an enhanced recovery program, continued work to ensure equitable healthcare for our patients, and more than 85% reduction in our facility's greenhouse gas emissions from inhaled anesthetics. The Bellevue Clinic and Surgical Center facility is a living example of a learning health system, which has evolved over the years through continued patient-centered QI work. Our areas of emphasis, including efficiency, effectiveness, efficacy, equity, and environmental safety, will continue to impact the community we serve positively.

Revisiting the IOM Reports and Envisioning a Promising Future for Public Health.

Two public health reports from the National Academies of Sciences, Engineering, and Medicine published in 1988 and 2003 by the Institute of Medicine continue to resonate. The COVID-19 pandemic highlighted the need for a robust and adequately funded public health system that has political and public support as well as strong connections to health care and other sectors. However, a spate of recent assessments of the nation's public health infrastructure shows continuing gaps in funding, workforce, capacity, and other dimensions. There are reasons for optimism and opportunities for progress in public health in the third decade of the 21st century. There is great promise in cross-sector partnerships and in embracing the "public" in public health by building power with communities in health improvement efforts and in decision-making. (Am J Public Health. 2024;114(5):495-500. https://doi.org/10.2105/AJPH.2024.307584).

The Utilization of the SaLux19-Based Loop-Mediated Isothermal Amplification (LAMP) Assay for the Rapid and Sensitive Identification of Minute Amounts of a Biological Specimen.

Our research has developed a highly sensitive and simple assay to detect small amounts of animal and human biological material in less than 40 min. The handheld SaLux19 device developed at the Max Planck Institute of Experimental Medicine in Göttingen, Germany, was used to validate our concept. The proposed system uses isothermal amplification of DNA in a rapid assay format. Our results show that the assay can detect Sus scrofa nucleic acids with very high sensitivity and specificity. This detection system has potential for forensic scenarios.

Protocol for the development of a consensus practice guideline To address clinical and regulatory barriers to buprenorphine dispensing in community pharmacy

BackgroundLess than half of community pharmacies in the United States stock buprenorphine products indicated for the treatment of opioid use disorder. This lack of access to buprenorphine in community pharmacies is a significant barrier to care. To address this issue, this protocol outlines a comprehensive approach to develop a practice guideline aimed at improving access to safe and effective opioid use disorder treatment in community pharmacies.MethodsThe guideline development process will proceed in three phases, following a technique closely aligned with the Institute of Medicine’s guidance on guideline development. The first phase will involve conducting qualitative interviews with pharmacists in three states to identify their beliefs toward buprenorphine dispensing. As limitations on buprenorphine supply are related to constraints at all levels of the drug supply and regulatory system, the second phase, we will recruit representatives from regulatory agencies, pharmacy organizations, the Drug Enforcement Administration, pharmaceutical wholesalers as well as addiction medicine physicians and psychiatric pharmacists to develop consensus recommendations through a modified Delphi design. This will be followed by a public comment period and external expert review of the recommendations led by the National Association of Boards of Pharmacy. Finally, in the third phase, a national, mixed media dissemination campaign will be led by the National Community Pharmacists Association (NCPA) to convey recommendations to practicing pharmacists.DiscussionThe guideline development process aims to incorporate the perspectives of multiple stakeholders and emphasize the importance of addressing the regulatory and pharmacy-specific aspects of care in addition to clinical evidence and guidance. The development of this guideline will provide targeted, multidisciplinary guidance for pharmacists, improving access to safe and effective opioid use disorder treatment in the community setting.PreregistrationThis protocol was registered with the Open Science Framework in March of 2023. Registration may be found at: https://doi.org/10.17605/OSF.IO/6S9DY.

The impact of gestational weight gain on fetal and neonatal outcomes: the Araraquara Cohort Study

BackgroundGestational weight gain (GWG) is an important indicator for monitoring maternal and fetal health. Objective: To evaluate the effect of GWG outside the recommendations of the Institute of Medicine (IOM) on fetal and neonatal outcomes.Study designA prospective cohort study with 1642 pregnant women selected from 2017 to 2023, with gestational age ≤ 18 weeks and followed until delivery in the city of Araraquara, Southeast Brazil. The relationship between IOM-recommended GWG and fetal outcomes (abdominal subcutaneous tissue thickness, arm and thigh subcutaneous tissue area and intrauterine growth restriction) and neonatal outcomes (percentage of fat mass, fat-free mass, birth weight and length, ponderal index, weight adequateness for gestational age by the Intergrowth curve, prematurity, and Apgar score) were investigated. Generalized Estimating Equations were used.ResultsGWG below the IOM recommendations was associated with increased risks of intrauterine growth restriction (IUGR) (aOR 1.61; 95% CI: 1.14–2.27), low birth weight (aOR 2.44; 95% CI: 1.85–3.21), and prematurity (aOR 2.35; 95% CI: 1.81–3.05), and lower chance of being Large for Gestational Age (LGA) (aOR 0.38; 95% CI: 0.28–0.54), with smaller arm subcutaneous tissue area (AST) (-7.99 g; 95% CI: -8.97 to -7.02), birth length (-0.76 cm; 95% CI: -1.03 to -0.49), and neonatal fat mass percentage (-0.85%; 95% CI: -1.12 to -0.58). Conversely, exceeding GWG guidelines increased the likelihood of LGA (aOR 1.53; 95% CI: 1.20–1.96), with lower 5th-minute Apgar score (aOR 0.42; 95% CI: 0.20–0.87), and increased birth weight (90.14 g; 95% CI: 53.30 to 126.99).ConclusionAdherence to GWG recommendations is crucial, with deviations negatively impacting fetal health. Effective weight control strategies are imperative.

Understanding the Complexity of Hyperglycemic Emergencies: Exploring the Influence of the Type and Duration of Diabetes Mellitus and Its Impact on Mortality.

Background Diabetes mellitus remains a pressing global health issue, characterized by chronic metabolic dysfunction and the potential for life-threatening acute hyperglycemic emergencies. These emergencies, known as diabetic ketoacidosis and hyperosmolar hyperglycemic states, trigger a series of physiological disruptions. This article delves deeply into how the type and duration of diabetes mellitus affect the occurrence of hyperglycemic emergencies and mortality rates. Methods The study was conducted at the Institute of Internal Medicine, Rajiv Gandhi General Hospital, affiliated with Madras Medical College, spanning from July 2021 to December 2021. It encompassed both individuals newly diagnosed with diabetic ketoacidosis and patients already undergoing diabetic treatment who developed diabetic ketoacidosis and hyperosmolar hyperglycemic states. Results Within the study cohort of 110 patients, 37.27% were diagnosed with Type 1 diabetes mellitus, while 62.73% were classified as Type 2 diabetes mellitus patients. Among these individuals, 23.60% were newly diagnosed with diabetes, 22.70% had been diabetic for less than one year, 47.30% had a diabetic history of two to five years, and 6.40% had been diabetic for over six years. However, upon investigating the relationship between diabetes duration and mortality rate, no statistically significant findings were observed. Conclusion Hyperglycemic emergencies represent multifaceted clinical challenges influenced by the interplay of various factors, including the type and duration of the disease. By maintaining effective management of hyperglycemia from the outset and sustaining it throughout their lives, people with diabetes can improve their physical and mental health and reduce the likelihood of developing long-term complications that may negatively impact their overall well-being.

Clinical practice guidelines for diagnostic and treatment of the chronic heart failure.

Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.

A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia.

We evaluated the efficacy of megestrol in improving chemotherapy-related anorexia by analyzing the related scales of taste alteration. We conducted the current study on a group of advanced patients with cancer with two or more chemotherapy cycles. The chemotherapy-induced taste alteration scale (CiTAs) scale helped assess the megestrol effects on basic taste perception, aversive taste changes, unpleasant symptoms, and associated concerns. Furthermore, the Short Nutritional Assessment Questionnaire scale (SNAQ) helped measure the impact of megestrol on malnutrition likelihood in patients experiencing chemotherapy-induced anorexia. The World Health Organization Quality of Life (WHOQOL)-BREF Scale was used to evaluate the quality of life of participants, producing scores related to physical health, psychological well-being, environmental factors, and social relationships. The CiTAs scale assessment indicated that administering megestrol significantly enhanced taste perception among advanced patients with cancer undergoing chemotherapy. Notably, the megestrol group patients showed significantly higher Short Nutritional Assessment Questionnaire (SNAQ) scores than the control group. The megestrol group patients also exhibited higher physiological (PHYS) scores than their control group counterparts. However, this distinction was not statistically significant. The study findings indicate that patients who received megestrol demonstrated significantly higher scores in psychological (PSYCH) and environmental(ENVIR) domains than the control group. Furthermore, megestrol administration was associated with significantly elevated SOCIL and ENVIR levels in patients. The proficient efficacy evaluation of megestrol in enhancing appetite, mitigating malnutrition likelihood, and improving the quality of life of chemotherapy-induced anorexic patients can be achieved through taste-related scales.

Oleg Konstantinovich Bumay (in memory of a teacher, colleague, comrade)

January 1, 2024 marked the 70th anniversary of the birth of the former head of the organization and tactics of the medical service of the fleet (with a course of tactics and combat weapons of the fleet) department of the S.M. Kirov Military Medical Academy, effective director for modern topics of the Federal State Budgetary Institution Research Institute of Industrial and Marine Medicine FMBA of Russia, candidate of medical sciences, associate professor Oleg Konstantinovich Bumay (1954–2022). O.K. Bumay was born in the village of Bogudenka, Belarus. He was alumnus the faculty of training doctors for the Navy of the S.M. Kirov Military Medical Academy. After graduating from the academy in 1977, for a decade he provided and organized medical support for nuclear submarines as the head of the ship’s medical service, the cheef of medical a submarine forces in the Northern Fleet, and subsequently served as a senior medical officer in the Baltic Fleet. Over the course of two decades, O.K. Bumay was associated with the organization and tactics of the naval medical service (with a course of tactics and combat weapons of the fleet) department of S.M. Kirov Military Medical Academy. In 1991, he entered the adjunct program at the department; upon completion of his studies, he was appointed as a teacher, subsequently as a senior teacher, and since 2009 — deputy head of the department. He received the rank of Philosophy doctor of Medical Sciences (1994), associate professor (1998). After leaving the Armed Forces of the Russian Federation in 2007, he continued his career as deputy director for special topics at the Federal State Budgetary Institution Research Institute of Industrial and Marine Medicine of the Federal Medical and Biological Agency of Russia. O.K. Bumay developed origins medical support system for the domestic nuclear submarine fleet. Was appointed on the post the head of the ship’s medical service and after that officer of the command-and-control body of an operational-tactical formation. Throughout their career he left a multifaceted scientific and practical legacy, which is used by new generations of naval doctors.