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项与 Hartford Hospital, Inc. 相关的文献（医药）

2024-12-01·Resuscitation Plus

Drowning incidents precipitated by unusual causes (DIPUCs): A narrative review of their diagnoses, evaluation and management

Review

作者: Ratzan, Richard M. ; London, Shawn ; Ratzan, Richard M ; Delgado, João H. ; Duignan, Kevin M ; Duignan, Kevin M. ; Delgado, João H ; Luu, Hannah

Drowning is a cause of significant morbidity and mortality worldwide. In most circumstances, the proximate cause is attributable to human factors, such as inexperience, fatigue, intoxication, or hazardous water conditions. The phenomenon of drowning incidents precipitated by unusual circumstances (DIPUCs) - either fatal or nonfatal - involving otherwise healthy individuals under generally safe conditions has not been comprehensively addressed in the medical and drowning literature to date. In this review, we discuss etiologies of DIPUCs, diagnostic clues, suggested workup, suggested postmortem testing, and implications for surviving patients and families. Identifying the cause of a drowning incident can be extremely challenging for the initially treating physician, relying perforce on historical context, environmental clues, physical exam, medical history, eyewitness accounts or video recordings. If no clear explanation for a drowning incident emerges despite a thorough investigation, clinicians should consider some of the less common diagnoses we describe in this paper, and, when appropriate, refer for an autopsy with postmortem molecular genetic testing. While time-consuming, these efforts can prove life-saving for some non-fatal drowning victims and the families of all victims of DIPUCs.

2024-12-01·International Journal of Cardiology

Enhancing risk assessment in Chagas cardiomyopathy: Electrophysiology study stratified by Rassi score

Article

作者: Martin, David ; Liberato, Christiane Bezerra Rocha ; Lima, Neiberg de Alcantara ; de Alcantara Lima, Neiberg ; Tavora, Ronaldo Vasconcelos ; Rocha, Eduardo Arrais ; Camanho, Luiz Eduardo Montenegro ; Neto, Almino Cavalcante Rocha ; Farias, Roberto Lima ; Vieira, Jefferson Luis ; Costa, Ieda Prata

BACKGROUNDChagas cardiomyopathy (CCM) is increasingly prevalent in developed countries due to migration from endemic areas. Accurate risk stratification is crucial due to the variable clinical course of CCM.OBJECTIVETo analyze the association between Rassi score progression and electrophysiology study (EPS) changes in CCM patients.METHODSThis prospective, observational cohort study involved CCM patients from two tertiary hospitals. Patients were classified as low, intermediate, or high risk based on the Rassi score. Data collected included demographics, clinical history, and diagnostic tests. EPS assessed AH, HH, and HV intervals, and inducibility of ventricular arrhythmias. Follow-ups were at 30 days and six-month intervals, with individualized discussions for cardiac implantable electric devices (CIED) based on EPS results.RESULTSOf 67 screened CCM patients, 59 underwent EPS. The mean Rassi score was 8.7 ± 4.5 points, with 33.8 % low, 38.9 % intermediate, and 27.1 % high risk. EPS abnormalities were found in 57.6 % of patients, mainly VT/VF (52.5 %). Most induced ventricular arrhythmias were monomorphic VT (80.7 %). A significant association was found between Rassi score risk classification and EPS changes (OR = 1.88 95 %CI: 1.15-3.06 p = 0.02). Higher Rassi scores correlated with VT presence on EPS (p = 0.0036). Syncope/pre-syncope had an OR 2.45 95 %CI:1.21-4.94; p = 0.012, independent of Rassi risk. Decreased ejection fraction was linked to EPS changes (p = 0.04).CONCLUSIONEPS changes among CCM was associated with progression of the Rassi score, indicating its utility as a stratification tool. Factors such as the presence of syncope/pre-syncope, decreased LVEF and wall motion abnormalities emerged as independent predictors within Rassi scores for changes in EPS.

2024-11-01·Breast Cancer Research and Treatment

Baseline sLAG-3 levels in Caucasian and African-American breast cancer patients

Article

作者: Ru, Karen ; Salner, Andrew L ; Ridwan, Sharif M ; Swede, Helen ; Strandberg, Jillian ; Kuo, Lynn ; Smilowitz, Henry M ; Sporn, Jonathan R

BACKGROUNDWorse survival persists for African-Americans (AA) with breast cancer compared to other race/ethnic groups despite recent improvements for all. Unstudied in outcomes disparities to date is soluble LAG-3 (sLAG-3), cleaved from the LAG-3 immune checkpoint receptor which is a proposed target for deactivation in emerging immunotherapies due to its prominent immunosuppressive function in the tumoral microenvironment. A prior study has found that lower sLAG-3 baseline level was associated with poor outcomes.METHODSIn a cross-sectional study of 95 patients with primary breast cancer (n = 58 Caucasian, n = 37 AA), we measured sLAG-3 (ELISA pg/ml) in pre-treatment blood samples using the non-parametric Mann-Whitney u-Test for independent samples, and, calculated Pearson r correlation coefficients of sLAG-3 with circulating cytokines by race.RESULTSMean sLAG-3 level was lower in AA compared to Caucasian patients (1377.6 vs 3690.3, P = .002), and in patients with triple-negative breast cancer (TNBC) compared to those with non-TNBC malignancies (P = .02). When patients with TNBC tumors were excluded from analyses, the difference in sLAG-3 level between AA (n = 21) and Caucasian patients (n = 40) substantially remained (1937.4 vs 4182.4, P = .06). Among Caucasian patients, sLAG-3 was correlated with IL-6, IL-8 and IL-10 (r = .69, P < .001; r = .70, P < .001; and, r = .46, P = .01; respectively). For AA patients, sLAG-3 was correlated only with IL-6 (r = .37, P = .03).CONCLUSIONSWe present the first report that African-American breast cancer patients might have comparatively low pre-treatment sLAG-3 levels, independent of TNBC status, along with reduced co-expression with circulating cytokines. The mechanistic and prognostic role of cleaved LAG-3, particularly in disparate outcomes, remains to be elucidated.

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