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The impact of social determinants of health on infant and maternal health using a reproductive justice lens
No full textBACKGROUND: Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill.
AIMS: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes.
METHODS: Data were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models.
RESULTS: Preterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3(rd) trimester were twice as likely to develop gestational hypertension.
CONCLUSIONS: SDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health
Mechanical outcomes of coronary stenting guided by intravascular ultrasound versus optical coherence tomography: A systematic review and meta-analysis with trial sequential analysis of randomized trials
No full textBACKGROUND: Intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may guide stent sizing and placement during percutaneous coronary intervention (PCI). We compared IVUS- vs. OCT-guided PCI in terms of mechanical outcomes.
METHODS: PubMed, Embase and Cochrane databases were systematically searched until December 2024 for randomized controlled trials (RCTs) comparing IVUS- vs. OCT-guided PCI. Random-effects models were used to estimate mean differences (MDs) and standard mean differences (SMDs) with 95 % confidence intervals (CIs).
RESULTS: Six RCTs with 2696 patients were included; 1396 (49.6 %) underwent IVUS-guided PCI. The mean age was 65.1 ± 10.2 years. In the pooled analysis, the post-PCI minimum stent area (MSA) was significantly higher with IVUS-guided PCI than with OCT-guided PCI (MD 0.64 mm(2); 95 % CI 0.17-1.10; p \u3c 0.01), and post-PCI mean diameter stenosis was significantly lower with IVUS (MD -1.05 %; 95 % CI -1.90 to -0.21; p = 0.01). There were no significant differences between groups in acute lumen gain, stent expansion index, malapposition, tissue protrusion, or edge dissection. In a subgroup analysis, IVUS-guided PCI yielded a greater MSA in studies that did not size vessels by measurement of the external elastic membrane. However, trial sequential analysis suggested that the RCTs to date have not reached the required quantity of information to support definitive conclusions about MSA and mean diameter stenosis.
CONCLUSION: This meta-analysis demonstrated that IVUS-guided PCI was associated with greater MSA and reduced diameter stenosis compared to OCT-guided PCI, with no difference in stent expansion index, more trials are required to confirm this hypothesis
Response to Letter to the Editor Regarding the Article Acute Myocardial Infarction and Stage E Shock: Insights From the RECOVER III Study
No full textEvidence of Hyperacetylation of Mitochondrial Regulatory Proteins in Left Ventricular Myocardium of Dogs with Chronic Heart Failure
No full textIncreased acetylation or hyperacetylation of mitochondrial (MITO) proteins can lead to abnormalities of the electron transport chain (ETC) and oxidative phosphorylation. In this study we examined the levels of proteins that regulate acetylation. Studies were performed in isolated MITO fractions from left ventricular (LV) myocardium of seven healthy normal (NL) dogs and seven dogs with coronary microembolization-induced heart failure (HF, LV ejection fraction ~35%). Protein levels of drivers of hyperacetylation, namely sirtuin-3 (Sirt-3), a MITO deacetylase, and CD38, a regulator of nicotinamide adenine dinucleotide (NAD(+)), were measured by Western blotting, and the bands were quantified in densitometric units (du). To assess MITO function, MITO components directly influenced by a hyperacetylation state, namely the protein level of cytophillin-D (CyPD), a regulator of MITO permeability transition pore and MITO Complex-I activity, were also measured. Protein level of Sirt-3 and amount of NAD(+) were decreased in HF compared to NL dogs. Protein levels of CD38 and CyPD were increased in HF compared to NL dogs. Complex-I activity was decreased in HF compared to NL dogs. The results support the existence of a protein hyperacetylation state in mitochondria of failing LV myocardium compared to NL. This abnormality can contribute to MITO dysfunction as evidenced by reduced Complex-I activity and opening of MITO permeability pores
Lithotripsy-Facilitated or Conventional Percutaneous Mitral Balloon Valvuloplasty for Calcific Mitral Valve Disease: A Systematic Review
No full textBACKGROUND: The efficacy of percutaneous mitral balloon valvuloplasty (PMBV) for mitral stenosis (MS) secondary to mitral annular calcification (MAC) is poorly understood. The purpose of this systematic review was to consolidate existing data on conventional and lithotripsy-facilitated PMBV in patients with calcific mitral valve disease, to better understand procedural outcomes.
METHODS: We performed a systematic search of the literature published in PubMed and Scopus databases through May 2024. We included all studies that reported outcomes of conventional PMBV as a standalone therapy or lithotripsy-facilitated mitral intervention for calcific mitral valve disease.
RESULTS: A total of 12 reports met the criteria for inclusion (8 lithotripsy and 4 conventional PMBV), including 4 case series and 8 case reports. Conventional PMBV (n = 44) procedural success in MAC was variable and associated with a limited reduction in mitral gradient in most patients. After conventional PMBV, 4 (9.1%) patients had moderate-to-severe mitral regurgitation (MR) or more, and 6 (13.6%) required mitral re-intervention. On the contrary, lithotripsy-facilitated PMBV for MAC (n = 40) led to hemodynamic improvement in most cases with a mean reduction of 5 to 8 mm Hg in mean mitral gradient. One case (2.5%) developed increased MR from baseline, and 1 (2.5%) required mitral reintervention. Outcomes beyond 3 months were lacking and precluded assessment on whether these improvements are sustained.
CONCLUSIONS: This systematic review suggests that lithotripsy-facilitated PMBV for MAC-related MS is feasible and may offer favorable short-term outcomes compared with conventional PMBV alone. These findings highlight the need for larger, multicenter studies with longer follow-up
Small Bowel Obstruction Secondary to Coiling of Gastric Electrical Stimulator Leads: A Rare Complication of Gastroparesis Management
No full textGastroparesis is a syndrome marked by delayed gastric emptying without mechanical obstruction, and surgical interventions such as gastric electrical stimulation (GES) are typically considered after conservative treatments fail. We present the case of a 53-year-old woman with idiopathic gastroparesis who had undergone GES placement 13 years prior and presented with three days of nausea, vomiting, and abdominal pain. CT imaging revealed a high-grade mechanical small bowel obstruction due to interval coiling and migration of the GES leads, which was confirmed intraoperatively; the patient underwent enterolysis, lead explantation, and placement of a new GES system. This case highlights a rare but serious complication of GES, with only three similar cases previously reported, and underscores the importance of recognizing lead migration as a potential cause of bowel obstruction. Clinicians, especially radiologists and surgeons, should closely assess for changes in lead position on imaging in symptomatic patients with implanted devices, as early diagnosis and intervention are critical to preventing severe outcomes such as bowel ischemia
Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories.
No full textLanguage features may reflect underlying cognitive and emotional processes following a traumatic event that portend clinical outcomes. The authors sought to determine whether language features from usual smartphone use were markers associated with concurrent posttraumatic symptoms and worsening or improving posttraumatic symptoms over time following a traumatic exposure. This investigation was a secondary analysis of the Advancing Understanding of RecOvery afteR traumA study, a longitudinal study of traumatic outcomes among survivors recruited from 33 emergency departments across the United States. Adverse posttraumatic sequelae were assessed over the six months following the initial traumatic exposure. Language features were extracted from usual smartphone use in a specialized app. Bivariate linear mixed models were used to identify and validate language features that are markers associated with posttraumatic symptoms. Participants were 1744 trauma survivors, with a mean age of 39 [SD = 13] years old, and 56% were female. Fourteen language features were associated with severity level of posttraumatic symptoms at specific timepoints (cross-sectional markers) and five features were associated with change in severity level of posttraumatic symptoms (longitudinal markers). References to the body and health or illness were predictive of worsening pain, somatic, and thinking/concentration/fatigue symptom severity over time. An increase in references to others was associated with improvement in somatic symptom severity over time and increases in expressions of causation or cognitive processes were associated with improvement in pain symptom severity over time. Language features derived from usual smartphone use can convey important information about health, functioning, and recovery following a traumatic event. Clinicians might utilize such information to determine who may experience a high symptom burden or risk of worsening posttraumatic symptoms
Assessing the Financial Sustainability of a Virtual Clinic Providing Comprehensive Diabetes Care
No full textINTRODUCTION: The Virtual Diabetes Specialty Clinic (VDiSC) study demonstrated the feasibility of providing comprehensive diabetes care entirely virtually by combining virtual visits with continuous glucose monitoring support and remote patient monitoring (RPM). However, the financial sustainability of this model remains uncertain.
METHODS: We developed a financial model to estimate the variable costs and revenues of virtual diabetes care, using visit data from the 234 VDiSC participants with type 1 or type 2 diabetes. Data included virtual visits with certified diabetes care and education specialists (CDCES), endocrinologists, and behavioral health services (BHS). The model estimated care utilization, variable costs, reimbursement revenue, gross profit, and gross profit margin per member, per month (PMPM) for privately insured, publicly insured, and overall clinic populations (75% privately insured). We performed two-way sensitivity analyses on key parameters.
RESULTS: Gross profit and gross profit margin PMPM (95% confidence interval) were estimated at -14.00 to 267.26 (277.93) and 73% (58%-88%) for privately insured patients; and 58.43-$340.39) and 67% (32%-102%) for the overall clinic. Profits were primarily driven by CDCES visits and RPM. Results were sensitive to insurance mix, cost-to-charge ratio, and commercial-to-Medicare price ratio.
CONCLUSIONS: Virtual diabetes care can be financially viable, although profitability relies on privately insured patients. The analysis excluded fixed costs of clinic infrastructure, and securing reimbursement may be challenging in practice. The financial model is adaptable to various care settings and can serve as a planning tool for virtual diabetes clinics
Bridging the gut and the heart-Exploring pathophysiology, risk factors, and therapeutic implications of cardiovascular disease in inflammatory bowel disease
No full textInflammatory bowel disease (IBD), including Crohn\u27s disease and ulcerative colitis, is a chronic systemic immune dysregulated disorder affecting the gastrointestinal tract that often has extraintestinal manifestations. Limited data exist on the cardiovascular (CV) implications of IBD, but a higher prevalence of CV disease (CVD) has been observed compared to the general population, resulting in increased mortality risk. This review examines the pathophysiology and risk factors linking IBD to CVD, highlighting several key mechanisms: The lipid paradox in active IBD, arterial stiffness and endothelial dysfunction, proinflammatory cytokine activity, gut microbiota dysbiosis, and drug-induced myocardiopathy. The main findings include information about IBD patients exhibiting a higher incidence of CVD compared to the general population, independent of traditional risk factors. Chronic inflammation, altered lipid profiles, and gut microbiome imbalances play a significant role in heightened CV risk. Routine CV risk assessment should be considered during clinical assessment, to integrate into IBD management. Anti-inflammatory therapies may reduce CVD risk, while careful consideration is needed for drugs with potential CV side effects. Further research is required to understand the complex interplay between IBD and CVD, particularly regarding the impact of novel therapies and lifestyle interventions on long-term CV outcomes in IBD patients