Risultati per: Report aggiornato sulla qualità dell’aria in Europa (2015)

Three-quarters of US adolescents reported at least 1 adverse experience, such as abuse, neglect, witnessing violence, or having a family member attempt or die by suicide during the COVID-19 pandemic, according to a CDC report. Youths reporting multiple adverse childhood experiences, or ACEs, were substantially more likely to report poor current mental health or a past-year suicide attempt than those without these experiences.

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Daoust R, Paquet J, Williamson D, et al. Accuracy of a self-report prescription opioid use diary for patients discharge from the emergency department with acute pain: a multicentre prospective cohort study. BMJ Open 2022;12:e062984. doi:10.1136/ bmjopen-2022-062984
This article has been corrected since it was published online. A collaborator group “On behalf of the OPUM research group” has been added to the author byline.

This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on screening for obstructive sleep apnea (OSA) in adults summarizes published evidence on the benefits and harms of screening for OSA in asymptomatic adults and use of positive airway pressure and mandibular advancement devices for treatment of OSA.

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Circulation, Ahead of Print. Aim:The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).Methods:A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.Structure:Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

Objectives
This study aims to estimate the prevalence, awareness, treatment and control rates of type 2 diabetes (T2D) and pre-diabetes as well as to identify its associated factors among Mongolians living in the Inner Mongolia Autonomous Region, China.

Design
Cross-sectional study.

Setting and participants
This sample included 11 361 Mongolian participants from the Inner Mongolian Healthy Aging Intervention Study, a population-based screening project consisting of 141 255 adults aged above 35 years in Inner Mongolia from 2015 to 31 December 2020.

Outcome measures
The prevalence and 95% CIs of T2D and pre-diabetes were calculated. Factors associated with the prevalence, awareness, treatment and control of T2D were explored by a binomial logistic regression.

Results
A total of 17.2% (95% CI 16.5% to 17.9%) of the sample had T2D, of whom 34.0% (95% CI 31.9% to 36.1%) were aware of their diagnosis, 24.7% (95% CI 22.8% to 26.6%) were taking prescribed antidiabetic medications, 6.7% (95% CI 5.6% to 7.8%) had achieved control and 27.5% (95 % CI 26.7% to 28.3%) had pre-diabetes. The prevalence of T2D increased with increasing age, male, lower education level, smoking, obesity and a history of hypertension or dyslipidaemia (all p

This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on hormone therapy for primary prevention of chronic conditions summarizes published evidence on the benefits and harms of estrogen only or estrogen plus progestin for the primary prevention of chronic conditions in generally healthy perimenopausal and postmenopausal persons eligible for hormone therapy.

Circulation, Volume 146, Issue Suppl_1, Page A10088-A10088, November 8, 2022. Electronic cigarettes (e-cigarettes) are advertised as a healthier alternative for combustible cigarettes and have become the most commonly used smoking product. There is limited data regarding the association of e-cigarettes and risk of cardiovascular disease (CVD). We assessed the association of chest pain reports across tobacco product use groups. We used data from the Population Assessment of Tobacco and Health (PATH) study which is a nationally representative longitudinal study of tobacco use behavior and health effects. We categorized tobacco use patterns into 4 groups: cigarette use, dual use, e-cigarette use, and non-use. Participants were asked if they have ever had chest pain and if they have had chest pain in the past 30 days. Binominal regression models were used to examine the association between tobacco use categories and the 2 chest pain outcomes. We adjusted for covariates including age, sex, race, education, BMI, hypercholesterolemia, hypertension, current use of other combustible tobacco products, secondhand smoke exposure, marijuana use in the past 30 days, recreational drug use and history of respiratory diseases. The cohort included 9,284 participants after excluding those with established CVD and those with missing outcome or exposure data. The Mean age was 57 (SD±11) years and 54% of participants were female. Among the participants, 3,020 were exclusive cigarette users, 213 were dual users, 175 were exclusive e-cigarette users (94% were former smokers), and 5,876 were non-users. Compared to non-use, combustible cigarette use had 1.48 (95% CI, 1.27, 1.73) odds of ever having chest pain and 1.72 (95% CI, 1.4, 2.11) odds of having chest pain in the past 30 days. Dual use was associated with 1.52 (CI 95%, 1.05, 2.19) odds of chest pain ever and 1.82 (95% CI, 1.17, 2.83) odds of 30 days chest pain. Exclusive e-cigarette use had 0.78 (95% CI, 0.49, 1.26) odds of ever having chest pain and 0.75 (95% CI, 0.39, 1.42) odds of having chest pain in the past 30 days. Our findings suggest that compared to non-use, exclusive e-cigarette use has similar rates of chest pain; whereas dual use and combustible cigarette use have increased rates of chest pain outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A14459-A14459, November 8, 2022. Introduction:Cardiobacterium hominis, part of the oropharyngeal flora, is a gram-negative bacteria reported to cause infection in less than 5% of patients with infective endocarditis (IE). In children, congenital heart disease (CHD) is a predominant risk factor for developing IE. Herein we describe an unusual presentation ofC. hominisbioprosthetic valve endocarditis.Case Presentation:A 23-year-old woman with bicuspid aortic valve and aortic valve stenosis underwent aortic bioprosthetic valve placement in 2017. In March 2022, she presented to an emergency room with left lower abdominal pain. A CT scan demonstrated occlusion of the left iliac artery. Medications at that time included oral contraceptive pills and baby aspirin. No echocardiogram was obtained at that visit. She presented for a routine cardiology follow-up in May 2022 at which time she was asymptomatic. Transthoracic echocardiogram demonstrated moderate to severe aortic insufficiency, though the mechanism could not be delineated. There was concomitant development of mild mitral valve and tricuspid valve insufficiency. She denied dyspnea, chest pain, or fevers. Laboratory investigation showed mild elevation of CRP and a normal ESR. A transesophageal echocardiogram demonstrated that the severe aortic regurgitation was through a paravalvar leak (figure 1). There was no evidence of vegetations. Three separate blood cultures grewC. hominis. The patient was admitted for IV antibiotic therapy prior to bioprosthetic replacement.Conclusions:C. hominisis an infrequent cause of endocarditis and most cases present with fever and elevated ESR. This patient had an unusual presentation with left iliac thrombus, which in retrospect was likely due to embolism of a vegetation. She also developed aortic bioprosthetic paravalvar leak. This case highlights the need for a high degree of suspicion for endocarditis in patients with CHD and bioprosthetic valves.

Circulation, Volume 146, Issue Suppl_1, Page A13191-A13191, November 8, 2022. Case Presentation:Infective endocarditis (IE) can sometimes be a diagnostic challenge because its presentation in its early stages may coincide with that of several other disease processes. It has an incidence of ~7 per 100,000 annually yet has an in-hospital mortality of about 20-25%. We present a case of a 56-year-old immunocompetent male with a recent diagnosis of leukocytoclastic vasculitis (LCV) who was admitted for acute renal failure (ARF). With his history of LCV (Figure 1), renal vasculitis was thought to be contributing to his ARF. On admission, he was afebrile and had a creatinine of 5.25 (baseline of 0.8), hyponatremia, anemia, mild leukocytosis, and mildly elevated lactate. No other infectious sequelae were noted. Nephrology was consulted for workup of renal failure, and a renal biopsy was recommended. Before the biopsy was able to be performed, blood cultures returned positive for Enterococcus faecalis. Transesophageal echocardiogram revealed a large, mobile 1.3-centimeter vegetation attached to the left ventricular outflow tract side of the non-coronary cusp of the aortic valve. Parenteral antibiotics were initiated, and cardiothoracic surgery was consulted for surgical correction. The patient ultimately underwent aortic valve replacement successfully with renal recovery to baseline and resolution of his leukocytoclastic vasculitis soon thereafter.Discussion:LCV has been established as a rare, but well-reported sign of IE. Similarly, only a few cases of IE presenting as ARF have been reported. In patients presenting with both LCV and ARF, it is important to maintain a high index of suspicion for IE. Going down the pathway to work up renal vasculitis may unnecessarily expose patients to invasive procedures, incorrect treatment modalities, and other complications.

Circulation, Volume 146, Issue Suppl_1, Page A14489-A14489, November 8, 2022. Clinical Case:A 37-year-old transgender (TG) woman off gender-affirming hormonal therapy (GAHT) presented with substernal chest pain radiating to the left arm, worse with exertion and relieved with res. She was hypertensive and tachycardic on admission. Initial bloodwork revealed an elevated troponin I of 0.57 ng/mL, which peaked at 1.48 ng/mL. EKG on admission showed hyperacute T waves in the anterior leads without ST elevation (see Figure 1). She was diagnosed with non-ST elevation myocardial infarction (NSTEMI) and taken for left heart catheterization (LHC).Decision-Making:TTE showed preserved LVEF and basal inferior, basal inferolateral, basal anterolateral and mid-anterolateral hypokinesis. LHC showed proximal-to-mid right coronary artery (RCA) occlusion. After failed aspiration thrombectomy indicating calcified plaque, two overlapping drug-eluting stents (DES) were successfully deployed with restoration of flow. She was discharged home on aspirin, ticagrelor, atorvastatin, and carvedilol.Discussion:Despite a recent push to increase awareness, research and healthcare equality specific to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients, a significant gap persists. Specifically, stress, inflammation, dyslipidemia, and thromboembolism predispose this understudied population to increased coronary artery disease (CAD) and myocardial infarction (MI). Accordingly, greater effort needs to be taken to mitigate preventable cardiac morbidity and mortality in this patient population.Conclusion:CAD in LGBTQ+ adults is well studied. However, there are few published studies on CAD specifically among TG men and women. National cross-sectional data highlights this disproportionate risk of CAD and MI among TG men and women relative to their cisgender female and male peers, a healthcare disparity recently emphasized by the AHA. Consequently, care must be taken to eliminate these aforementioned inequalities.

Circulation, Volume 146, Issue Suppl_1, Page A14471-A14471, November 8, 2022. Introduction:Sarcoidosis is a multi-system disorder of unknown etiology that is commonly associated with hilar lymphadenopathy and granulomas. Cardiac involvement is less common, however, sarcoidosis is a known cause of restrictive cardiomyopathy. It typically presents as new-onset arrhythmias or heart failure, although cases of sudden cardiac death have been reported.Case presentation:We present a case of a 56-year-old male with a known history of pulmonary sarcoidosis, not on any active treatment, who presented to the emergency department with one week of continuous hiccups every few seconds associated with non-exertional dyspnea. Initial CT scan of the chest showed multiple stellate-like ground-glass opacities and progression of bronchiectasis. Troponins were negative. On the initial EKG, he was found to be in atrial flutter and was admitted to the general medical floor. He was given baclofen and the hiccups resolved over the next 24 hours. Cardiology was consulted for suspected cardiac sarcoidosis and they recommended transferring the patient to the tertiary care center for further evaluation. Upon arrival, the patient underwent catheter ablation for atrial flutter and he returned to the sinus rhythm after the procedure. The initial nuclear scan with gallium was not suggestive of cardiac sarcoidosis, however, subsequent cardiac MRI showed cardiac involvement. Due to the high risk of arrhythmias, the patient was scheduled for implantable cardioverter defibrillator placement before discharge. Treatment with steroids was deferred until after the PET scan could be completed. The patient was discharged in stable condition and interrogation of the device found it to be well functioning and with no significant arrhythmias noted.Conclusions:Presentation of cardiac sarcoidosis can be variable and should be considered in any patient with a known history of sarcoidosis who presents with atypical symptoms at or above the level of the diaphragm, such as hiccups or with new-onset arrhythmias.

Circulation, Volume 146, Issue Suppl_1, Page A14762-A14762, November 8, 2022. Introduction: Anti-neoplastic agents that target vascular endothelial growth factor (VEGF) are known to have cardiovascular toxicities, principally hypertension, with a reported incidence of 21-40% in first-time users. Anti-VEGF induced hypertension can be challenging to control, and significant enough to lead to a dose reduction or discontinuation of the VEGF-targeted therapy, preventing patients from completing their cancer therapy.Methods:A single center prospective cohort of patients with cancer starting anti-VEGF therapy was compared to a retrospective control cohort that was 1:1 matched on gender, race, ethnicity, cancer type, and anti-VEGF therapy. For the prospective cohort, antihypertensive medications were started per an anti-VEGF hypertension algorithm. Elevated blood pressure was defined as consecutive blood pressure readings above 140/90 mmHg and control of blood pressure defined as consecutive readings

Circulation, Volume 146, Issue Suppl_1, Page A9436-A9436, November 8, 2022. Introduction:Left Atrial Septal pouch (LASP) is defined as an incomplete closure between the septum primum and septum secundum with an elongated septum secundum. This produces a crevice in the left atrium that functions as a source for static blood and atrial dissociation. This in turn could progress to the formation of thrombi within the left atrium that has the potential to embolize causing ischemic infarcts.Case Description:Here we present a 63 year old Hispanic female with a past medical history of paroxysmal atrial fibrillation on apixaban, recurrent strokes, dyslipidemia, and hypertension who presented with expressive aphasia, and prosopagnosia. Previously, the patient was reported of having two cardioembolic cerebral vascular accidents (CVA). Computed tomography of the brain demonstrated an old infarct of the left posterior parietal lobe. Patient was treated with intra-arterial tissue plasminogen activator of the left posterior cerebral artery and right middle cerebral artery. MRI demonstrated four acute punctate infarcts in the left frontal lobe consistent with embolic infarcts. TEE demonstrated a large patent foramen ovale (PFO), a prominent eustachian valve, and LASP. It was determined that her PFO and LASP were the culprit for her recurrent CVA despite appropriate AC. The PFO/LASP were successfully closed with an Amplatzer PFO occluder device. Patient was discharged home.Discussion:The LASP can function as a source of thrombus formation and atrial disassociation, which can cause embolic CVA. No guidelines exist on how to properly address a LASP. One option would be to use a PFO closure device to close LASP. Other options may include AC despite the absence of atrial fibrillation.Conclusions:In conclusion, further studies are necessary in order to establish the most appropriate management in patients with LASP.