Internal and emergency medicine
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Non-invasive respiratory support, namely, non-invasive ventilation, continuous positive airway pressure, and high-flow nasal cannula, has been increasingly used worldwide to treat acute hypoxemic respiratory failure, giving the benefits of keeping spontaneous breathing preserved. In this scenario, monitoring and controlling respiratory drive could be helpful to avoid patient self-inflicted lung injury and promptly identify those patients that require an upgrade to invasive mechanical ventilation. ⋯ Further, we analyze and compare the leading strategies implemented for respiratory drive monitoring and discuss the sedative drugs and the non-pharmacological approaches used to modulate respiratory drive during non-invasive respiratory support. Refining the available techniques and rethinking our therapeutic and monitoring targets can help critical care physicians develop a personalized and minimally invasive approach.
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Observational studies revealed paradoxically inverse associations between diabetes and aortic diseases (aortic aneurysm or aortic dissection), yet the causality remains to be determined. To investigate the causal associations between diabetes and aortic diseases using Mendelian randomization (MR) analyses. Summary-level data for exposures (type 1 diabetes, type 2 diabetes, fasting glucose, fasting insulin, glycated hemoglobin) and outcomes (aortic dissection and aortic aneurysm) were obtained from public genome-wide association study data. ⋯ MR-Egger method and funnel plot yielded no indication of directional pleiotropy. Diabetes had no causal associations with aortic dissection or aortic aneurysm. The observed inverse associations in previous cohort studies may be explained by confounding factors or reverse causation.
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The relationship between sedentary lifestyle and chronic diseases is well known. This study examined the prevalence and factors associated with reduced physical activity (PA) among internal medicine inpatients on admission. In this single-center, cross-sectional study, inpatients aged 50 years or older were prospectively enrolled at a tertiary care facility in Ankara, Türkiye. ⋯ Outdoor walking < 3 days per week (OR: 4.44, 95% CI 1.55 to 12.74, p = 0.006, functional dependence in and outside home (OR: 4.25, 95% CI 1.13 to 15.92, p = 0.032) and EQ-5D VAS score (OR: 0.97, 95% CI 0.95 to 0.99, p = 0.011) were independently associated with low PA level on multivariable logistic regression analysis. This study found low or medium levels of PA in almost nine out of ten admissions to an internal medicine clinic. On the other hand, low PA level was not associated with most classical comorbidities but with altered performance and care indicators.