Internal and emergency medicine
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Multicenter Study Observational Study
Assessing risk of major adverse cardiac event among COVID-19 patients using HEART score.
Coronavirus disease 2019 (COVID-19) is known to be associated with cardiovascular complications, but whether the current validated HEART score for chest pain is still applicable for these patients is unknown. This study aims to identify the impact and association of COVID-19 co-infection in patients presenting with chest pain and a calculated HEART score to the emergency departments (ED) with 30-day of major adverse cardiac event (MACE). This is a multicenter, retrospective observational study that included adult (age ≥ 18 years) patients visiting 13 different EDs with chest pain and evaluated using a HEART score. ⋯ Older age in COVID-19 had higher AUROC (0.89) than control patients (0.63). Among patients presenting to the ED with chest pain and having COVID-19 infection, HEART score had predictive capability for MACE, similar to patients without COVID-19 infection. Further studies with more COVID-19 patients are still necessary to confirm our observation.
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Observational Study
Albumin as a prognostic marker of 30-day mortality in septic patients admitted to the emergency department.
Assessing the evolutive risk of septic patients in the emergency department (ED) is very complex. Predictive tools are available, but at an early stage, none of them can detect the tissue microvascular alterations underlying the septic process. Hypoalbuminemia is present in critically ill patients in the ICU, and some early indications also suggest its early role in septic patients. ⋯ Serum albumin concentration measured during initial ED assessment can be a useful prognostic marker of 30-day mortality in septic patients.
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Comment Review
The interaction of bile acids and gut inflammation influences the pathogenesis of inflammatory bowel disease.
Bile acids (BA) are amphipathic molecules originating from cholesterol in the liver and from microbiota-driven biotransformation in the colon. In the gut, BA play a key role in fat digestion and absorption and act as potent signaling molecules on the nuclear farnesoid X receptor (FXR) and membrane-associated G protein-coupled BA receptor-1 (GPBAR-1). BA are, therefore, involved in the maintenance of gut barrier integrity, gene expression, metabolic homeostasis, and microbiota profile and function. ⋯ These factors contribute to impaired repair capacity of the mucosal barrier, due to chronic inflammation. A better understanding of BA-dependent mechanisms paves the way to innovative therapeutic tools by administering hydrophilic BA and FXR agonists and manipulating gut microbiota with probiotics and prebiotics. We discuss the translational value of pathophysiological and therapeutic evidence linking BA homeostasis to gut inflammation in IBD.
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Compliance with core sepsis measures in Emergency Departments (ED) remains low, with a limited number of prospective trials highlighting strategies for improvement. ⋯ The ED -based implementation of a sepsis tracking sheet and the involvement of dedicated ED pharmacists was effective in improving core measures of sepsis compliance. Patients receiving higher fluid aliquots did not experience higher rates of respiratory interventions, though had higher all-cause mortality. No relationship could be identified between patients getting lower aliquots of fluid and prior diagnoses of volume overload.
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Observational Study
Comparison of the prognostic value, feasibility, and reproducibility among different scoring methods of 8‑point lung ultrasonography in patients with acute heart failure.
There is no strong evidence that one of the B-line quantification approaches is clinically superior to the others, as the use of lung ultrasound (LUS) protocol becomes more commonplace in the treatment of heart failure (HF). This study, thus, aimed to evaluate to the prognostic value, feasibility, and reproducibility for selecting optimal B-line quantification methods. We enrolled patients with HF admitted to the emergency intensive care unit (EICU) in a single-center, prospective, observational study. ⋯ Image interpretation time of Quantitative methods 1 and 2 was significantly less than that of other methods. Intraclass correlation coefficients (ICC) for B-pattern scoring systems (Quantitative methods 1 and 2) between two experts demonstrated the excellent level of clinical significance. Despite the similar discrimination, calibration and clinical usefulness, pattern-B scoring systems have the benefit of the feasibility and reproducibility over other methods.