Articles: disease.
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Sleep-disordered breathing has a relatively high prevalence, which varies from 3-7% in males and from 2-5% in females in the adult population. Studies published in the literature have shown that sleep apnea is closely related to an increased risk of developing various pathologies, among which arterial hypertension stands out. The prevalence of hypertension in patients suffering from obstructive sleep apnea (OSA) ranges from 35-80% and appears to be related to OSA severity. ⋯ The primary objective of this narrative review is to provide an update on what are the main contributing comorbidities to the development of a hypertensive state in patients suffering from OSA, an independent risk factor for diurnal hypertension, implicated as a risk factor for the first stroke, recurrent stroke, and post-stroke mortality. There are a lot of factors that contribute to developing a hypertensive state in OSA patients, some more decisive, others less. More evidence from longitudinal studies is needed on the impact of OSA on cardiovascular risk in females, on the causal link between OSA and arterial hypertension or metabolic diseases, like diabetes and glucose intolerance, and the effect of different kinds of OSA treatment.
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Mayo Clinic proceedings · Feb 2024
ReviewClinical Trials for Special Populations: Children, Older Adults, and Rare Diseases.
Research cannot maximize population health unless it improves health for all members of the public, including special populations such as children, older adults, and people living with rare diseases. Each of these categories require special considerations when planning and performing clinical trials, and common threads of ethical conduct of research in vulnerable populations appear throughout. In this review, definitions of each of the three categories of special population (children, older adults, and rare diseases) are discussed in terms of US research regulations, the unique challenges to conducting clinical trials for these special populations, critical ethical issues, and opportunities for innovative ways to design and operationalize clinical trials in special populations. Additional critical attention is focused on factors that influence the generalizability of study results to reduce health disparities, as well as the importance of community engagement and advocacy groups that can help to educate potential trial participants of the benefits of clinical trial participation.
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During the coronavirus disease 2019 (COVID-19) pandemic, reports of vaccine-induced myocarditis, particularly messenger ribonucleic acid (mRNA)-based myocarditis, were widely spread. This case series describes various cases of COVID-19 vaccine-induced myocarditis confirmed by cardiac magnetic resonance imaging (MRI), including those who were administered rare protein-based vaccines. Eleven patients comprising eight males and three females with suspected myocarditis underwent cardiac MRI at Taichung Veterans General Hospital between October 2021 and May 2022. ⋯ Among four patients with reduced left ventricular ejection fraction (LVEF), two showed LVEF restoration during the follow-up period, and the other two were lost to follow-up. Cardiac MRI characterizes myocardial features such as edema, inflammation, and fibrosis, and has been proven to diagnose myocarditis accurately with a sensitivity of 87.5% and a specificity of 96.2% according to the 2018 Lake Louise criteria. This diagnosis was achieved without invasive procedures such as endomyocardial biopsy or coronary angiography.
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J Coll Physicians Surg Pak · Feb 2024
Acyclovir-Induced Nephrotoxicity in Adults with Viral Encephalitis.
To determine the frequency of parenteral Acyclovir-induced Acute Kidney Injury (AKI) in patients with viral encephalitis. ⋯ Acyclovir, Acute kidney injury, Viral encephalitis, Creatinine, Kidney Disease Improving Global Outcomes.
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Internal medicine journal · Feb 2024
Beyond the aspirational: Creating the future of health care in Australia.
The context of health care in Australia is shifting very rapidly; more chronic diseases, budgetary stress and the constant threat of the next pandemic and climate change mean that patterns of disease and care are changing, and the workforce is under pressure. Health systems have learned to respond as best they can, but there are many challenges and opportunities for the Australian health care system to plan and implement an evidence-based and sustainable approach to health care delivery in the next decade. ⋯ Here, we outline nine strategies that span principles of integrated, value-based care, with a focus on prevention and quality, the development of a skilled workforce and health-literate population and the use of emerging technologies such as genomics and artificial intelligence. These strategies form a potential path for the Australian health care system to meet the changing requirements of the current decade and take the aspirational visions of the future of health care into an improved, patient-based health system that delivers care in line with best practices.