The American journal of the medical sciences
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Dysregulation of the circadian rhythm is linked to immune response deficiencies. Diurnal temperature variation-a surrogate for the circadian rhythm, exists in humans, yet its preservation during illness is not well understood. ⋯ Hospitalization is associated with disruption in the circadian rhythm as reflected by patients' body temperature. Since abnormality in body temperature is known to affect patient outcomes, an understanding of the diurnal cycle during hospitalization is the first step towards devising approaches to re-establish the circadian rhythm.
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As the Modified Anticoagulation and Risk Factors in Atrial Fibrillation Risk Score (M-ATRIA-RS) encompasses prognostic risk factors of novel coronavirus-2019 (COVID-19), it may be used to predict in-hospital mortality. We aimed to investigate whether M-ATRIA-RS was an independent predictor of mortality in patients hospitalized for COVID-19 and compare its discrimination capability with CHADS, CHA2DS2-VASc, and modified CHA2DS2-VASc (mCHA2DS2-VASc)-RS. ⋯ M-ATRIA-RS is useful to predict in-hospital mortality among patients hospitalized with COVID-19. In addition, it is superior to the mCHA2DS2-VASc-RS in predicting mortality in patients with COVID-19 and is more easily calculable than the CCI score.
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Mechanical ventilation is a potentially life-saving therapy for patients with acute lung injury, but the ventilator itself may cause lung injury. Ventilator-induced lung injury (VILI) is sometimes an unfortunate consequence of mechanical ventilation. It is not clear however how best to minimize VILI through adjustment of various parameters including tidal volume, plateau pressure, driving pressure, and positive end expiratory pressure (PEEP). ⋯ There is currently interest in quantifying how static and dynamic parameters contribute to VILI. One concept that has emerged is the consideration of the amount of energy transferred from the ventilator to the respiratory system per unit time, which can be quantified as mechanical power. This review article reports on recent literature in this emerging field and future roles for mechanical power assessments in prospective studies.
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Asymptomatic cardiac involvement in systemic sclerosis (SSc) has been reported. Long-term follow-up might elucidate the clinical implications of these abnormalities. The aim was to identify the clinical outcomes of asymptomatic cardiac involvement in SSc patients after 2 years of follow-up. ⋯ Cardiac involvement in SSc can progress slowly or even be reversed. Based on a previous test, the incidence of symptomatic cardiac involvement after 2 years was low despite its being a persistent involvement. If symptomatic cardiac involvement develops, PAH is the most prevalent symptom.
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The therapeutic benefits and rationale for treating fevers with external cooling methods remain unclear. We aimed to describe the clinical settings in which cooling blankets (CBs) are used. ⋯ Documentation of CB use including temperature set points, time of discontinuation and duration in EMRs was poor. We could not establish benefits of CB use in this study but observed that almost a third of patients developed adverse effects in the form of shivering. Thus, adverse effects of CB use may outweigh potential benefits. Their use should be reevaluated and institutional protocols developed for their use.