Background: No studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes. Methods: Using cross-sectional data from the 2015-2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (>1.0 mg/L) in 14,544 Koreans aged ≥19 years who responded to the SRH survey and had hs-CRP test results. Differences in sociodemographic factors were analyzed using Pearson's chi-square test for categorical variables or the Mann-Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders. Results: The percentage of having a very poor to poor SRH was higher in the high hs-CRP level group (22.4%) than in the low hs-CRP level group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend <0.001). After adjusting for all confounders, including chronic diseases, men with a very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with a very good SRH (fully adjusted OR, 1.74; 95% con dence interval, 1.04-2.90). Signi cant correlations were absent among women. Conclusions: A poor SRH was correlated with low-grade in ammation (high hs-CRP level) among male Korean adults. The ndings could be useful for developing health improvement programs and in goal setting at a national scale. Background Self-rated health (SRH) is an index utilized worldwide to summarize how patients perceive their overall health status [1]. SRH is an independent predictor of mortality and disease morbidity, even after adjusting for demographic, sociological, and medical risk factors [2]. Despite criticisms that SRH is assessed based on a single question, it is known to be a strong predictor in both healthy and unhealthy individuals. SRH is not only a predictor of previously diagnosed disease but also a predictor of reactions associated with the progression of disease in the premorbid stage; it encapsulates recent or sporadic health issues that may be missed by one-time objective testing, and it also re ects behavioral and emotional factors [2, 3]. C-reactive protein (CRP) is produced by hepatocytes following acute tissue injury or infection. Though CRP levels are generally elevated in cases of severe in ammation, high-sensitivity CRP (hs-CRP) levels increase nonspeci cally in the event of in ammation in the body. In particular, hs-CRP is used as an indicator to assess the risk of cardiovascular disease (CVD), and several studies have suggested hs-CRP as a predictor of mortality. In assessing CVD risk, the American Heart Association (AHA) and Centers for Disease Control and Prevention (CDC) de ned hs-CRP levels of >3.0 mg/L as indicating high risk, 1.0-3.0 mg/L as indicating average risk, and <1.0 mg/L as indicating low risk...
RationaleMyocardial injury associates significantly and independently with mortality in COVID-19 patients. However, the pathogenesis of myocardial injury in COVID-19 remains unclear, and cardiac involvement by SARS-CoV-2 presents a major challenge worldwide.ObjectiveThis histological and immunohistochemical study sought to clarify the pathogenesis and propose a mechanism with pathways involved in COVID-19 myocardial injury.Methods and ResultsPostmortem minimally invasive autopsies were performed in six patients who died from COVID-19, and the myocardium samples were compared to a control group (n=11). Histological analysis was performed using hematoxylin-eosin and toluidine blue staining. Immunohistochemical (IHC) staining was performed using monoclonal antibodies against targets: caspase-1, caspase-9, gasdermin-d, ICAM-1, IL-1β, IL-4, IL-6, CD163, TNF-α, TGF-β, MMP-9, type 1 and type 3 collagen. The samples were also assessed for apoptotic cells by TUNEL. Histological analysis showed severe pericardiocyte interstitial edema and higher mast cells counts per high-power field in all COVID-19 myocardium samples. The IHC analysis showed increased expression of caspase-1, ICAM-1, IL-1β, IL-6, MMP-9, TNF-α, and other markers in the hearts of COVID-19 patients. Expression of caspase-9 did not differ from the controls, while gasdermin-d expression was less. The TUNEL assay was positive in all the COVID-19 samples supporting endothelial apoptosis.ConclusionsThe pathogenesis of COVID-19 myocardial injury does not seem to relate to primary myocardiocyte involvement but to local inflammation with associated interstitial edema. We found heightened TGF-β and interstitial collagen expression in COVID-affected hearts, a potential harbinger of chronic myocardial fibrosis. These results suggest a need for continued clinical surveillance of patients for myocardial dysfunction and arrythmias after recovery from the acute phase of COVID-19.
Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.
RESUMOOBJETIVO: Esse trabalho visa avaliar um modelo de curso para a capacitação da equipe de enfermagem no atendimento de urgências e emergências, estabelecendo o período pelo qual o conhecimento adquirido no curso é memorizado e o prazo em que deveria ser reaplicado para garantir a proficiência. MÉTODOS: Foram selecionados 45 profissionais da enfermagem que atuavam nas unidades de cardiologia e aplicado um pré-teste de 20 questões de múltipla escolha, avaliando o conhecimento prévio da equipe. Após o pré-teste, ministrou-se um curso teórico-prático presencial acerca do reconhecimento de pacientes críticos e manejo inicial de uma parada cardiorrespiratória, praticando as manobras de reanimação em um manequim. Após o curso era reaplicado o mesmo teste para identificar se houve melhora no número de acertos. Dentro de três e seis meses o teste foi novamente aplicado, a fim de estabelecer a taxa de memorização do conhecimento no período. RESULTADOS: Observamos que a média de acertos no pré-teste foi de 9,4±3,3 questões. No pós-teste imediato houve um aumento da média de acertos para 15,3±2 questões. Após três meses, o número médio de acertos caiu para 12±3,1 questões e transcorridos seis meses foi de 10±3,3 questões. Foi possível identificar ainda que os profissionais que atuavam na Unidade de Cuidados Intensivos e Hemodinâmica apresentaram um maior número de acertos (12,6±3,42) quando comparados com os profissionais que atuavam na Enfermaria (9,4±4,4). Realizando uma análise regressiva, observamos uma melhora estatisticamente significativa nos resultados dos testes logo após o treinamento e em três meses (p<0.05) -o que não ocorreu em seis meses. CONCLUSÃO: Podemos inferir a partir da melhora no número de acertos que o modelo de curso teórico-prático presencial foi efetivo em promover a capacitação dos profissionais da enfermagem. No entanto, a fixação do conhecimento decai ao longo dos meses, retornando a valores próximos do inicial em seis meses. ABSTRACTAIMS: This work aims to evaluate a course model for the training of the nursing team in emergency care, as well as establishing the period which the knowledge acquired in the course is still memorized and when the course should be reministered to guarantee the professional's proficiency. METHODS: We selected 45 nursing professionals who worked at the Cardiology Units of the Hospital de Clínicas of the Federal University of Paraná. In this group, a pre-test of 20 multiple choice questions was applied, mentioning the previous knowledge of the team. After the pre-test, a two-hour theoretical-practical course was given on the recognition of severe patients and initial management of a cardiorespiratory arrest, practicing ventilation maneuvers and chest compression on a manikin. After the course, the same test was reapplied to identify if there was improvement in the number of correct answers. Within three and six months the test was again applied in order to establish the knowledge storage rate over that period. RESULTS: We observed that the average accuracy in the pr...
In this study, varying degrees of vacuolar degenerative tubular changes were present in all patients, but there were no signs of acute tubular necrosis. It seems that in the present study a prerenal cause of acute renal failure was the main involved mechanim to explain the cause of renal failure in these patients.
Introduction: Several theories have been proposed to explain the cause of ‘aging’; however, the factors that affect this complex process are still poorly understood. Of these theories, the accumulation of oxidative damage over time is among the most accepted. Particularly, the heart is one of the most affected organs by oxidative stress. The current study, therefore, aimed to investigate oxidative stress markers in myocardial tissue of rats at different ages. Methods: Seventy-two rats were distributed into 6 groups of 12 animals each and maintained for 3, 6, 9, 12, 18 and 24 months. After euthanasia, the heart was removed and the levels of non-protein thiols, lipid peroxidation, and protein carbonylation, as well as superoxide dismutase and catalase activities were determined. Results: Superoxide dismutase, catalase activity and lipid peroxidation were reduced in the older groups of animals, when compared with the younger group. However, protein carbonylation showed an increase in the 12-month group followed by a decrease in the older groups. In addition, the levels of non-protein thiols were increased in the 12-month group and not detected in the older groups. Conclusion: Our data showed that oxidative stress is not associated with aging in the heart. However, an increase in non-protein thiols may be an important factor that compensates for the decrease of superoxide dismutase and catalase activity in the oldest rats, to maintain appropriate antioxidant defenses against oxidative insults.
Rationale: Myocardial injury is significantly and independently associated with mortality in COVID-19 patients. However, the pathogenesis of myocardial injury in COVID-19 is still not clear, and cardiac involvement by SARS-CoV-2 remains a major challenge worldwide. Objective: This histopathological and immunohistochemical study seeks to clarify the pathogenesis and propose a mechanism with pathways involved in COVID-19 myocardial injury. Methods and Results: Postmortem minimally invasive autopsies were performed in six patients who died from COVID-19, and the myocardium samples were compared to a control patient. Histopathological analysis was performed using hematoxylin-eosin and toluidine blue staining. Immunohistochemical (IHC) staining was performed using monoclonal antibodies against the following targets: caspase-1, ICAM-1, TNF-α, IL-4, IL-6, CD163, TGF-β, MMP-9, type 1 and type 3 collagen. The samples were also subjected to a TUNEL assay to detect potential apoptosis. The histopathological analysis showed severe pericellular interstitial edema surrounding each of the cardiomyocytes and higher mast cells count by high-power field in all COVID-19 myocardium samples. The IHC analysis showed increased expression of caspase-1, ICAM-1, IL-4, IL-6, CD163, MMP-9 and type 3 collagen in the COVID-19 patients compared to the control. No difference from the control was observed in expression of TNF-α, TGF-β and type 1 collagen. The TUNEL assay was positive in all the COVID-19 samples confirming the presence of endothelial apoptosis. Conclusions: The pathogenesis of COVID-19 myocardial injury seems to be related with pyroptosis leading to endothelial cell injury and disfunction. The subsequent inflammation with associated interstitial edema could explain the myocardial disfunction and arrythmias in these patients. Our findings also show that COVID-19 myocardial injury may cause myocardial fibrosis in the long term. These patients should be monitored for myocardial dysfunction and arrythmias after the acute phase of COVID-19.
Acute colonic pseudobstruction (Ogilvie's syndrome) is a severe, life threatening condition characterized by acute colonic distension without evidence, or mechanical obstructive factor. Prompt detection results in an early colonoscopy treatment, which results in better prognosis. We report the case of a 57 year old female patient, with a previously diagnosed follicular lymphoma which presented with severe abdominal distention, impairing adequate thoracic expansion. The abdominal CT performed showed a significant dilatation of the cecum (13.27cm), with no mechanical obstruction. A decompressive colonoscopy was performed, with immediate clinical response.
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