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Advancement of the Dragon Heart 7-Series for Pediatric Patients With Heart Failure.
No full textBACKGROUND: Safe and effective pediatric blood pumps continue to lag far behind those developed for adults. To address this growing unmet clinical need, we are developing a hybrid, continuous-flow, magnetically levitated, pediatric total artificial heart (TAH). Our hybrid TAH design, the Dragon Heart (DH), integrates both an axial flow and centrifugal flow blood pump within a single, compact housing. The axial pump is embedded in the central hub region of the centrifugal pump, and both pumps rotate around a common central axis, while maintaining separate fluid domains.
METHODS: In this work, we concentrated our design and development effort on the centrifugal blood pump by performing computational modeling. An iterative process was employed to improve the DH design. The pressure generation, scalar stress levels, and fluid forces exerted on the magnetically levitated impellers were computationally estimated. A shaft driven centrifugal prototype was also manufactured and tested using a hydraulic flow loop circulating a water-glycerol blood analog. Pressure and flow performance of the pump prototype was measured for a given rotational speed for comparison to computational predictions.
RESULTS: Our design achieved the target pump pressures of 60-140 mm Hg for flow rates of 1-5 L/min, and strong agreement in pressure rise was demonstrated between the experimental data and simulation results (less than 10% deviation on average). Fluid stress levels were, however, found to exceed thresholds in the outflow region of the pump, and fluid residence times were less than 600 ms.
CONCLUSION: The findings of this work demonstrate that the more compact, next-gen DH\u27s centrifugal pump design is able to achieve pressure-capacity requirements. Next steps will require a focused strategy to reduce hemolytic potential and to integrate magnetic suspension components for full rotor levitation
The Aftermath of Overturning Roe v. Wade: A Review of Legal, Social, and Health Implications
No full textRoe versus Wade occurred in 1973 and was a landmark case in the United States. It guaranteed the right to abortion until 2022, when the Dobbs versus Jackson case was decided and the U.S. Supreme Court overturned Roe. This abolished the right to abortion and left it up to the states. The Dobbs decision has reshaped the framework for reproductive rights in the United States. This paper focuses on the multifaceted outcomes of the Dobbs decision, highlighting the legal, social and health implications. Through a study of recent research, legal analyses, and public health reports, this article assesses the broader aspects of the decision
Response to Concerns on Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis .
No full textCorynebacterium pseudotuberculosis Central Line-Associated Bloodstream Infection in an Infant with Short Gut Syndrome
Get PDFDid we try THAT yet? Empowering the Medical-Surgical Team to Prioritize Interventions Before Rapid Response Activation
Get PDFSepsis Caused by Ewingella americana in an Immunocompromised Patient: A Case Report.
No full textHuman infections caused by Ewingella americana have been rarely described. We report a case of E. americana in a cancer patient undergoing chemotherapy, who developed sepsis during a red blood cell transfusion. This causative pathogen was identified through the patient\u27s blood culture. The patient was treated with ceftriaxone and showed complete clinical improvement, with no further growth of E. americana or other pathogenic isolates in subsequent blood cultures. To the best of our knowledge, this is the first reported case of E. americana infection in a cancer patient undergoing chemotherapy in Türkiye
Management of psychiatric comorbidities in fibromyalgia patients treated with pregabalin versus milnacipran
No full textFibromyalgia is a debilitating chronic disease with symptoms of pain and fatigue that profoundly impact a patient\u27s quality of life. This can lead to the development of psychiatric comorbidities causing compounding decline in overall well-being. While the treatment options available for fibromyalgia are limited, pregabalin (a y-aminobutyric acid analog) and milnacipran (a serotonin-norepinephrine reuptake inhibitor) are options for patients seeking relief. Based on these mechanisms of action, it is likely that milnacipran might be more effective at treating and preventing comorbid psychiatric conditions than pregabalin. We used TrinetX, deidentified health care organization (HCO) network, to collect and analyze our data. Patients with fibromyalgia who were not receiving opioid analgesics were included in the study, and separated into treatment groups if they were prescribed pregabalin or milnacipran. Risk ratios, hazard ratios, Kaplan Meier analysis, and log rank test were performed to analyze the differences in psychiatric comorbidities, somnolence, opioid use disorder, depressive episodes, and anxiety disorder. Our results suggest that milnacipran has a statistically significant decreased in risk of somnolence (1.3%, CI 95%= 0.9-1.8%, p=0.00010. opioid use disorder (0.9%, CI 95%=0.6-1.2%, p0.0001) and depressive episodes (2.7%, CI 95% = 1.5-4.0%, p=0.0001) compared to the pregabalin group, but no significant difference when comparing anxiety disorder (1%, CI 95%=-0.3-2.3% p+0.119). log rank tests also show that all patients treated with milnacipran had a statistically significant increase in time to diagnosis for all psychiatric conditions assessed compared to pregabalin (somnolence 10.12%, p0.001; opioid use disorder 1.6%, p0.001; depressive episode 7.77%, p=0.001; anxiety disorder 4.48%, p=0,008). Overall, the data suggest that milnacipran might be more effective at reducing psychiatric comorbidities and overall increase the time to psychiatric diagnoses of these patients. However, further research is needed to determine the clinical significance of these findings
Unresponsive and Undiagnosed: A Journey Through SAG Meningitis and AOP Stroke
No full textObjective: To report a case of Streptococcus anginosus (SAG) meningitis manifesting as Artery of Percheron (AOP) stroke, emphasizing need for early recognition and management. Background: SAG meningitis, though uncommon, is signifcant cause of brain infarcts and should be included in differential diagnoses. It can lead to serious complications including ventriculitis, brain abscesses, vertebrobasilar strokes, and acute hydrocephalus. Prompt recognition and treatment with intravenous antibiotics, and surgical drainage if needed, are essential for better outcomes. Design/Methods: Case Report Results: A 73-year-old female was brought to hospital in unresponsive state, following six days of headaches and fevers. Her blood pressure was 90/50 mmHg, and Glasgow Coma Scale was 4, necessitating intubation. Examination revealed comatose state, left gaze deviation, and no response to noxious stimuli in right extremities. Initial stroke assessments, including non-contrast CT, CT angiogram and perfusion, were unremarkable. Due to unknown last known well, she wasn\u27t a candidate for thrombolytics. Bloodwork showed mild leukocytosis, diabetic ketoacidosis, and uremia. She was admitted to ICU and started on antimicrobials with meningitis coverage. Blood cultures grew SAG. CSF studies on day three suggested bacterial meningitis. CSF cultures, gram stains, and panels for meningitis/encephalitis and paraneoplastic syndromes returned negative, leading to discontinuation of antivirals. Although her metabolic issues improved, her neurological status declined. Long-term EEG revealed no seizures. MRI was not performed due to incompatible spinal nerve stimulator. Subsequent CT scans revealed evolving infarcts in left internal capsule, bilateral thalami, and midbrain. With no additional sources of infection identifed, and after discussions with family, she was transitioned to comfort care. Conclusions: AOP infarcts present a diagnostic challenge that demands strong clinical suspicion. To our knowledge, this is frst reported case of AOP stroke resulting from SAG meningitis. This case highlights importance of early recognition of stroke and its etiology, for timely intervention and improved patient outcomes
Comparative Effectiveness of GLP-1 Receptor Agonists in Patients with Heart Failure with Preserved or Minimally Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
No full textIntroduction: Heart failure with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF) remains difficult to manage, especially in patients with type 2 diabetes (T2D) or obesity. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are emerging therapies, but their comparative effectiveness is unclear. Methods: A Bayesian network meta-analysis (NMA) of six randomized controlled trials (RCTs) involving 24,099 patients was conducted. Systematic searches were performed across PubMed, Embase, Scopus, and Cochrane Library databases with maintaining PRISMA flowchart. Analyses used R (v4.4.3) with random-effects model selected by deviance-information criterion (DIC). Effect sizes included hazard ratios (HR) for time-to-event outcomes and mean differences (MD) for continuous outcomes. Treatment ranking was evaluated using Surface Under the Cumulative Ranking Curve (SUCRA). Results: Semaglutide significantly reduced hospitalization for heart failure [HHF], (HR: 0.52, 95%, CrI [0.25, 0.87]); [Fig-1] and worsening HF events (HR: 0.33, 95%, CrI [0.13, 0.68]). It also improved 6-minute walk distance (MD: +17.09 meters, SUCRA: 75.9%); [Fig-3] and reduced body weight (MD: -8.35%, SUCRA: 60.8%); [Fig-5]. Tirzepatide demonstrated the greatest weight reduction (MD: -12.07%, SUCRA: 87.9%) and ranked highest for HHF reduction (SUCRA: 76.9%). Exenatide had the best ranking for all-cause mortality (HR: 0.73, SUCRA: 86.9%); [Fig-4] while semaglutide ranked best for cardiovascular mortality (HR: 0.83, SUCRA: 75.1%); [Fig-2]. Conclusion: Semaglutide and tirzepatide offer superior outcomes for patients with HFpEF/HFmrEF. Semaglutide improves cardiovascular and functional endpoints, while tirzepatide provides the greatest weight loss. These therapies may significantly enhance care for patients with coexisting obesity or T2D
Pathophysiological Effects on Coronary Arteries Following Radiofrequency Ablation: A Comprehensive Review.
No full textRadiofrequency ablation (RFA) is a safe and effective treatment for patients experiencing ventricular and atrial tachyarrhythmias. While complications after RFA are generally rare, the occurrence of coronary artery (CA) injury, albeit infrequent, can have significant clinical implications. Given the proximity of CAs to common ablation sites, understanding the interplay between RFA and CA perfusion pathophysiology is paramount. Although previous studies have discussed the presentation and outcomes of CA injury post-ablation, a comprehensive review consolidating the mechanisms of CA injury following RFA remains absent in the cardiology literature. In this review, we conducted an extensive literature search spanning the past three decades to explore the link between the biophysics of RFA and CA perfusion pathophysiology, focusing on injury mechanisms. We delve into RFA lesion pathology, elucidate the mechanisms of CA injury resulting from RFA, and examine factors influencing lesion formation, such as convective cooling and the shadow effect. Furthermore, we outline methods to mitigate CA injury post-RFA and propose novel research avenues to optimize lesion formation and ensure the safety of arrhythmia treatments, particularly in cases where tissue ablation is performed close to CAs