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Cor Triatriatum: A Review
No full textCor triatriatum is a rare congenital cardiac anomaly, characterized by a fibromuscular partition dividing the left (cor triatriatum sinister) or, rarely, the right atrium (cor triatriatum dexter). Occurring in 0.1-0.4% of congenital heart disease cases, it exhibits diverse clinical presentations, often mimicking mitral stenosis and left-sided heart failure, while occasionally remaining asymptomatic into adulthood. The embryological origin of cor triatriatum remains controversial. Recent years have seen the emergence of new classification systems that offer enhanced prognostic insights. Transthoracic echocardiography is the diagnostic cornerstone. Surgical resection, preferably under cardiopulmonary bypass, is the mainstay treatment, and is associated with favorable long-term outcomes
Sacubitril-Valsartan (LCZ696) in the Treatment of Systemic Hypertension an Updated Review of Neprilysin Inhibition Combined With Angiotensin II Receptor Blockade
No full textSacubitril-valsartan (LCZ696) has been demonstrated to be a highly effective treatment for heart failure with preserved ejection fraction since its Food and Drug Administration approval in 2015, and a growing body of evidence suggests its emergence as a hypertensive medication. It acts as an inhibitor of both neprilysin and the renin-angiotensin-aldosterone system, approaching the control of a multi-faceted pathology in multiple unique ways. Because 48% of US adults are affected by hypertension, with less than half of patients achieving controlled blood pressure, and the high correlation between uncontrolled hypertension and cardiovascular mortality, it is crucial to investigate new pharmacotherapies for managing this disease. This review discusses the current evidence of sacubitril-valsartan trials in hypertension management, with a focus on distinct populations and hypertension subsets. Asian populations are predisposed to salt-sensitive hypertension and have been shown to benefit from sacubitril-valsartan more than olmesartan, an angiotensin receptor blocker (ARB). Systolic hypertension from stiff, aging arteries commonly affects individuals over the age of 65 years, and responds demonstrably better to sacubitril-valsartan than ARB monotherapy. Patients with treatment-resistant hypertension, especially those with heart failure, also show significantly improved blood pressure when treated with sacubitril-valsartan over ARBs. We conclude with a discussion of sacubitril-valsartan’s potential role in managing noncardiac disease
Low-Dose Colchicine for the Prevention of Cardiovascular Events After Acute Coronary Syndrome
No full textColchicine, an established anti-inflammatory drug, is examined for its potential in mitigating adverse cardiovascular events following acute coronary syndrome (ACS). ACS, primarily triggered by plaque rupture and subsequent thrombosis, is a critical cardiovascular condition. Colchicine’s mechanism of action involves inhibiting microtubule activity, leading to immobilization of white blood cells and reducing inflammation. Clinical data from studies, including low-dose colchicine for secondary prevention of cardiovascular disease two and colchicine cardiovascular outcomes trial, support its efficacy in reducing major cardiovascular events post-ACS, though some studies report varying results. Colchicine can cause transient gastrointestinal side effects and is prescribed with caution in patients with certain medical conditions. The recent FDA approval of a low dose of colchicine reiterates its benefit in reducing cardiovascular risk. The cost-effectiveness of colchicine products (0.5 and 0.6 mg doses) are compared, suggesting the generic 0.6 mg dose of colchicine to be an alternative to branded forms of the drug
Lipoprotein(A): A Review of Risk Factors, Measurements, and Novel Treatment Modalities
No full textThe study of lipoprotein(a) [Lp(a)] has long been a source of interest as a possible independent risk factor for atherosclerotic cardiovascular disease (ASCVD). The results of large sample observational studies, genome-wide association studies, and Mendelian randomization studies have been strong indicators supporting the link between ASCVD and Lp(a) despite early studies, with less sensitive assays, failing to show a connection. The recommendations for the indications and frequency of testing Lp(a) levels vary between US, Canadian, and European organizations due to the uncertain role of Lp(a) in ASCVD. The innovation of recent therapies, such as antisense oligonucleotides and small interfering RNA, designed to specifically target and reduce Lp(a) levels by targeting mRNA translation have once more thrust LP(a) into the spotlight of inquiry. These emerging modalities serve the dual purpose of definitively elucidating the connection between elevated Lp(a) levels and atherosclerotic cardiovascular risk, as well as the possibility of providing clinicians with the tools necessary to manage elevated Lp(a) levels in vulnerable populations. This review seeks to examine the mechanisms of atherogenicity of Lp(a) and explore the most current pharmacologic therapies currently in development
Development of the European Society of Hypertension Guidelines for the Management of Arterial Hypertension: Comparison of the Helpfulness of ESH 2013, 2018, and 2023 Guidelines
No full textObjective: Over the last decade, the European Society of Hypertension (ESH) published several guidelines (GLs) for the Management of Arterial Hypertension (2013, 2018, and 2023). We hypothesized that the GL has been improved because of the publications of new evidence. Thus, we aimed to examine the development of ESH guidelines (ESH GLs) by comparing their helpfulness regarding the diagnosis and treatment of hypertension. Methods: A novel mathematical analysis was used to compare ESH GLs. Not only the frequency of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) were examined but a newly developed certainty index (CI) was calculated. This CI allows the CLASS and LEVEL to be assessed together, providing a less biased assessment of GLs, than examining the CLASS and LEVEL independently or related to each other. Results: The number of recommendations showed continuous and significant increases from 2013 (N¼110) to 2018 (N¼169), and 2023 (N¼269). Examining the frequency of CLASS and/or LEVEL led to biased results, showing both improvements and/or worsening comparing years. However, based on the new analysis, a continuous improvement was shown in the percentage of certainty from 2013 to 2023 (2013: 60.5%, 2018: 72.1%, 2023: 75.3%). Accordingly, the CI was also significantly increased from 2013 (CI: 0.21), to 2018 (CI: 0.44), and to 2023 (CI: 0.51). Conclusion: The analysis shows that compared to previous GLs, the structure of the ESH 2023 GL has been rearranged and simplified. The higher number of Recommendations indicates a continuously accumulating knowledge regarding the mechanisms, clinical findings, and epidemiology of hypertension. Moreover, the ESH 2023 GL shows a higher degree of certainty and CI, corresponding to a higher level of helpfulness of the ESH 2023 GL for healthcare professionals to diagnose, prevent, and treat hypertension
Utilization of Preference Signaling in Dermatology Residency Applications During the 2023-2024 Match Cycle: A Program Leadership Survey
No full textThe National Resident Matching Program, also known as The Match,ital uses a Nobel Prize-winning algorithm to determine the residency placement for fourth-year medical students. Dermatology remains one of the most competitive specialties within The Match ital. A process of preference signaling was implemented to allow applicants to express interest in individual residency programs at the time of application. The impact, significance, and best use of these signals remain unclear. This study aimed to elucidate the utilization and perceived impact of the signaling schema as it pertains to the 2023-2024 Match in Dermatology. The survey results provide valuable insights into the influence and impressions of signaling from the perspective of dermatology residency program leadership. The results may inform the advising of future applicants and evolution of the signaling schema of The Match italprocess
Reoperative Left Ventricular Assist Device Insertion Following Previous Coronary Artery Bypass Grafting: Less Invasive versus Sternotomy Approach
No full textPurpose: Reoperative durable left ventricular assist device (LVAD) insertion after coronary artery bypass grafting (CABG) is challenging due to potential injury to bypass grafts, great vessels, or the right ventricle (RV). We sought to compare the less invasive (LI) approach to the full sternotomy (FS) technique for LVAD implantation in patients with a prior history of CABG. Methods: From March 2012 to April 2023, 29 patients with a history of CABG underwent reoperative LVAD implantation: Group FS, N = 16, and Group LI, N = 13. The LI approach includes an upper hemisternotomy and left thoracotomy without dissecting around the RV and bypass grafts. Results: The median age was 68 years in Group FS and 70 years in Group LI (p = 0.83). HeartMate II was only used in group FS (FS: 56.3% [N = 9] vs. LI: 0%), whereas HeartWare (FS: 31.3% [N = 5] vs. LI: 53.8% [N = 7]) and Heartmate 3 (FS: 12.5% [N = 2] vs. LI: 46.2% [N = 6]) were used in both groups. None of the patients experienced intraoperative injury of bypass grafts. In isolated LVAD implantation, cardiopulmonary bypass time was comparable between groups (FS: 92 [68, 96] min vs. LI: 82 [61, 96] min, p = 0.33). The incidence of severe RV failure requiring mechanical support was lower in Group LI (FS: 43.8% [N = 7] vs. LI: 0%, p = 0.02). Hospital mortality was numerically lower in the LI group (FS: 31.3% [N = 5] vs. LI: 9.1% [N = 1], p = 0.35). One-year estimated survival rates were not significantly different (FS: 68.8% ± 11.6% vs. LI: 81.8% ± 11.6%, p = 0.85). Conclusions: The less invasive technique for reoperative LVAD insertion after CABG may improve outcomes by reducing RV failure
Length of Stay of Patients Who Presented to the ED With Flank Pain and Received a CT Scan
No full textAttention Bias in School-Age Children Who Stutter: Evidence From a Dot-Probe Task
No full textPurpose: Cognitive models of anxiety attribute anxiety and ruminative thought patterns to selective processing of threat-related stimuli that automatically capture attention. We explored whether stuttering was associated with similar attentional biases by examining: (a) whether school-age children who stutter (CWS) differed from controls in selective processing of threat-related and neu-tral stimuli and (b) whether attentional biases in CWS were specific to threat stimuli that reflected stuttering-related experience. Method: Participants included 39 children (19 CWS), ages 8 to 15 years. Children completed a dot-probe task in which they responded as quickly as possible to on-screen probes that replaced threat-related or neutral words. Three types of threat words were presented: (a) general threat words; (b) words related to stuttering; and (c) personalized words on which participants anticipated stuttering. Attention bias (AB) was computed based on reaction times for congruent conditions (probe replaced threat stimuli) relative to incongruent conditions (probe replaced neutral stimuli) and compared across groups and stimulus types. Results: Strong evidence for an AB effect was observed for CWS but not for controls, as demonstrated by faster responses to congruent relative to incongruent trials. Within the stuttering group, AB effects were driven primarily by stuttering-related and personal words but not general threat words. Conclusions: Findings indicate that CWS preferentially allocate attention toward stimuli relevant to stuttering experiences. Further research is needed to clarify how such selective processing may contribute to the development of stuttering-related concerns, psycho-emotional reactions to stuttering, and associated behaviors, such as avoidance of sounds, words, or speaking situations
Attrition From Care and Barriers to Prep Use Among Key Populations in Kinshasa, DRC: A Multiple Methods Study
No full textFemale sex workers (FSW) and gay and other men who have sex with men (MSM) are disproportionately affected by HIV. Oral pre-exposure prophylaxis (PrEP) is increasingly available in African countries, including the Democratic Republic of Congo (DRC), but data on factors influencing PrEP use remain limited. This multiple methods study examined PrEP attrition patterns and barriers to engagement among FSW and MSM in Kinshasa, DRC, using programmatic data from five sites, clinical records, and qualitative interviews. Logistic regression identified factors associated with attrition; qualitative data were thematically analyzed. Among 8,822 FSW and MSM eligible for PrEP in 2019–2021, only 24% (n = 2,070) initiated it. Of 809 FSW initiators, 33% (n = 268) were lost to follow-up by 1 month and 78% (n = 421) by 3 months. Among 1,261 MSM, 26% (n = 332) and 87% (n = 808) were lost by 1 and 3 months, respectively. For FSW, prior PrEP use and recent STIs were associated with higher attrition at 1 month. Older age, more sexual partners, income beyond sex work, and no prior PrEP use were linked to lower attrition at 3 months. Among MSM, no prior PrEP use predicted higher attrition at 1 month but lower attrition at 3 months. Qualitative findings identified stigma, side effects, dislike of daily dosing, and limited services for key populations at risk of HIV as major barriers. Findings underscore the need for improved PrEP messaging, including information on side effects decreasing over time. Raising awareness among key and general populations may reduce stigma and improve PrEP engagement