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Coronary Artery Disease and Human Immunodeficiency Virus
No full textCardiac complications in individuals infected with the human immunodeficiency virus (HIV) have been recognized since the 1980s. However, the type of cardiac conditions seen in this population has changed substantially since the introduction of antiretroviral therapy (ART). Coronary artery disease (CAD) has emerged as a leading cause of morbidity and mortality in HIV positive individuals. HIV and ART have both been linked to the development of CAD through multiple mechanisms. There is limited specific guidance for management of CAD and its risk factors in people with HIV. This literature review explores the pathophysiology and management of CAD in HIV-infected patients, identifying gaps in evidence and areas for future research to address the growing burden of CAD in this patient population.
Keywords: Anti-retroviral therapy; Coronary artery disease; Human immunodeficiency virus
Corrigendum to \u27Preemptive anticoagulation during antenatal pulmonary embolism diagnostics in a community setting: retrospective cohort study\u27: [Research and Practice in Thrombosis and Haemostasis Volume 9, Issue 1, January 2025, 102695]
No full textNo evidence of a detrimental effect of pitavastatin on neurocognitive function among people with HIV
No full textObjective: Effects of statins on neurocognitive function remain poorly understood, with some studies suggesting harm and others suggesting benefit. Limited observational data among people with HIV (PWH) is biased by indication for statin prescription. We sought to assess statin effects on neurocognitive function among PWH.
Design: We leveraged data from participants co-enrolled in REPRIEVE (randomized trial of pitavastatin vs placebo among PWH with low-to-moderate cardiovascular risk) and HAILO (observational study involving repeated neurocognitive measures).
Methods: Participants with ≥1 measure of neurocognitive function before and after REPRIEVE randomization were included. Neurocognitive function was determined by NPZ-4, the average of the Z scores from: Hopkins Verbal Learning Test Revised, Trailmaking A and B, and Digit Symbol Test every 48 weeks. Trajectories before and after randomization were analyzed with generalized estimating equation models.
Results: Of 181 co-enrolled participants (pitavastatin 88, placebo 93), changes over median 2.3 years on overall and individual neurocognitive scores were small, not meeting a clinically relevant threshold of \u3e0.5/year, and similar between arms. Although subgroup analyses were limited by a small sample size, we observed trends towards improved Trailmaking A in participants with baseline impairment who were randomized to pitavastatin vs placebo and towards worsened NPZ-4 in females randomized to pitavastatin vs placebo that similarly did not reach threshold for clinical relevance. Other subgroup effects were minimal and not statistically or clinically significant.
Conclusions: We found no evidence of a detrimental effect of pitavastatin use on a limited battery of neurocognitive assessments among PWH, even among PWH with baseline neurocognitive impairment.
Keywords: HIV; dementia; neurocognition; randomized clinical trial; statin
Gender-specific effects of appendectomy on inflammatory bowel disease: Increased odds of Crohn\u27s disease, and decreased odds of ulcerative colitis in women-An analysis using the National Inpatient Sample
No full textThis study investigates the gender-specific and demographic associations of appendectomy on the concurrent diagnosis of inflammatory bowel disease (IBD), using data from the National Inpatient Sample (2018-2021), comprising 25,950,053 hospitalized patients. Among the cohort, there were a total of 1,207,569 patients who underwent an appendectomy during the hospitalization. Similarly, there were 648,751 and 338,357 patients with a diagnosis of ulcerative colitis (UC) and Crohn\u27s disease (CD), respectively. Multivariate logistic regression models were employed to assess the association between appendectomy and IBD diagnoses, adjusting for age, gender, race, income, and hospital division. Patients who underwent an appendectomy during hospitalization had a 68% lower odds of concurrent UC diagnosis compared to those without an appendectomy (odds ratio (OR) 0.32; 95% confidence interval (CI) 0.18-0.58; p \u3c 0.001). Female patients showed a 10% lower odds of UC diagnosis compared to male patients (OR 0.90; 95% CI 0.87-0.93; p \u3c 0.001). However, the interaction between appendectomy and gender was not statistically significant (OR 1.15; 95% CI 0.50-2.65; p = 0.746). For CD, patients undergoing an appendectomy during hospitalization had increased odds of CD diagnosis compared to those without an appendectomy (OR 1.42; 95% CI 1.12-1.80; p = 0.003). Female patients showed a significantly higher odds of CD diagnosis compared to males (OR 1.42; 95% CI 1.12-1.80; p = 0.003). Regional disparities and racial differences in IBD diagnosis were also observed. These findings suggest that patients with UC and CD have differential risks of appendectomy and may influence the development of UC and CD, with gender-specific variations. Further studies are needed to explore the underlying mechanisms.
Keywords: Inflammatory bowel disease; appendicitis; biostatistics; colitis; colonoscopy
Comorbidity patterns and mortality in HFpEF: A retrospective longitudinal cohort study
No full textBackground: Comorbid conditions (CCs) in heart failure with preserved ejection fraction (HFpEF) are associated with poor prognosis, but the influence of their duration on mortality remains unclear. We examined how pre-admission comorbidity duration affects long-term mortality after HFpEF hospitalization.
Methods: This retrospective study included adults hospitalized for HFpEF at 17 hospitals (2010-2022) with follow-up through July 2024. Twelve individual and four system-based comorbidities present at admission were classified by duration: new (\u3c 0.5 years), early (0.5-\u3c 3 years), intermediate (3-\u3c 6 years), and long-term (\u3e6 years). Mortality was further stratified by Get With The Guidelines-Heart Failure (GWTG) score (1, 2, ≥3) and discharge SGLT2i prescription. Cox regression and restricted cubic splines estimated risk.
Results: Among 9256 patients (mean age 77.8 years; 54.1 % female; 40.2 % rural), 64.1 % died over a median follow-up of 2.7 years. Comorbidity prevalence ranged from 6.0 % (neurological) to 73.4 % (hypertension), with durations from 0.5 years (obesity) to 5 years (diabetes). Most comorbidities increased mortality risk (HRs 1.06-1.25), highest for neurological disease, CKD, stroke, and anemia. Risk rose within 3 years of comorbidity onset, then stabilized, consistent across age, sex, and residential status. Associations persisted across GWTG strata. SGLT2i therapy attenuated mortality risk for most comorbidities, though residual risk remained for stroke, CKD, chronic lung, and neurological disease.
Conclusions: In HFpEF, comorbidities are common and associated with higher mortality, especially within the first 3 years. Prognostic effects persisted across GWTG strata, while SGLT2i therapy attenuated these risks, highlighting the importance of early detection and optimized therapy.
Keywords: Age; Comorbidities; Heart failure; Mortality; Rural-urban; Sex
Brain dynamics reflecting an intra-network brain state is associated with increased posttraumatic stress symptoms in the early aftermath of trauma
No full textPost-traumatic stress (PTS) encompasses a range of psychological responses following trauma, which may lead to more severe outcomes such as post-traumatic stress disorder (PTSD). Identifying early neuroimaging biomarkers that link brain function to PTS outcomes is critical for understanding PTSD risk. This longitudinal study examines the association between brain dynamic functional network connectivity (dFNC) and current/future PTS symptom severity, and the impact of sex on this relationship. By analyzing 275 participants\u27 dFNC data obtained ~2 weeks after trauma exposure, we noted that brain dynamics of an inter-network brain state link negatively with current (r=-0.197, p corrected = 0.0079) and future (r=-0.176, p corrected = 0.0176) PTS symptom severity. Also, dynamics of an intra-network brain state correlated with future symptom intensity (r = 0.205, p corrected = 0.0079). We additionally observed that the association between the network dynamics of the inter-network and intra-network brain state with symptom severity is more pronounced in female group. Our findings highlight a potential link between brain network dynamics in the aftermath of trauma with current and future PTSD outcomes, with a stronger effect in female group, underscoring the importance of sex differences
Response to: Letter to Editor: Prehospital Management of Spinal Cord Injuries, Calland et al
No full textClinical outcomes of transcatheter pulmonary valve replacement versus surgical pulmonary valve replacement: A meta-analysis
No full textInsulin Conservation: Meeting Demand While Reducing Waste
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1022/thumbnail.jp
From Burnout to Balance: Enhancing ED Triage Through Scheduled Rotations
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1011/thumbnail.jp