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How John Fetterman Came Out of the Darkness
When he looks back on the past year—a year in which he nearly died, became a U.S. Senator, and nearly died again—it is the debate that John Fetterman identifies as the ­breaking point. “The debate lit the mitch,” he says, then shakes his head in frustration and tries again. The right word is there in his brain, but he struggles to get it out. “Excuse me, that should be lit the mitch—” He stops and tries again. “Lit the match,” he says finally. Oct. 25, 2022: the date is lodged in his mind. “I knew I had to do it,” he tells me. “I knew that the vote...
Source: TIME: Health - July 20, 2023 Category: Consumer Health News Authors: Molly Ball Tags: Uncategorized Congress Cover Story Exclusive feature uspoliticspolicy Source Type: news

What is Ondine ’ s Curse?
Discussion Congenital central hypoventilation syndrome (CCHS) is an autosomal dominant with variable inheritance genetic disease caused by mutation in the Paired Like Homeobox B2 (PHOX2B) gene on chromosome 4. There are two other genes which may also cause CCHS. CCHS affects the chemoreceptor afferent ventilation pathways and is a neural crest migration problem of the autonomic nervous system. The incidence is unknown but a prevalence of 1 in 200,000 live births has been reported. Obviously it is a rarer phenomenon because of the general lethality of the syndrome. Patients usually present at birth or soon afterwards, but o...
Source: PediatricEducation.org - August 15, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Preoperative preparation and premedication of bariatric surgical patient
Marina Varbanova, Brittany Maggard, Rainer LenhardtSaudi Journal of Anaesthesia 2022 16(3):287-298 The prevalence of obesity has tripled worldwide over the past four decades. The United States has the highest rates of obesity, with 88% of the population being overweight and 36% obese. The UK has the sixth highest prevalence of obesity. The problem of obesity is not isolated to the developed world and has increasingly become an issue in the developing world as well. Obesity carries an increased risk of many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, sleep...
Source: Saudi Journal of Anaesthesia - June 20, 2022 Category: Anesthesiology Authors: Marina Varbanova Brittany Maggard Rainer Lenhardt Source Type: research

What Medications Prevent Delirium in Elderly Medical Inpatients?
This study demonstrated lower rates of delirium in the melatonin arm, with an impressive number needed to treat (NNT) below six patients; mortality and length of hospital stay were unaffected.3 A delirium-prevention effect of melatonin has not been reproduced in other studies, notably Jaiswal et al, which randomized patients to a placebo or 3 mg of melatonin and found no difference in rates of delirium prevention.7  The melatonin receptor agonist ramelteon also has small but favorable evidence for preventing non-ICU hospitalized delirium. This comes from a study of 67 patients aged 65 years or older who were randomized to...
Source: The Hospitalist - May 2, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Drug Therapy Geriatrics Key Clinical Questions Medication Source Type: research

Role of Dexmedetomidine in Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Scoping Review
Dexmedetomidine (DEX), an α2-adrenergic agonist, has been widely used for anesthesia, pain control, and intensive care unit sedation. Besides sleep-like sedation, DEX has many other beneficial effects, such as anti-inflammation, antioxidation, and anticell death. Subarachnoid hemorrhage (SAH), a severe and potentially fatal form of stroke, is a complex disease that is divided into 2 phases: early brain injury and delayed cerebral ischemia. In each phase, several pathologic changes are involved, including disturbed intracranial homeostasis, metabolic failure, blood-brain barrier damage, vasospasm, microthrombosis, and cort...
Source: Journal of Neurosurgical Anesthesiology - March 15, 2022 Category: Anesthesiology Tags: Review Articles Source Type: research

Anesthetic management for robotic hysterectomy in obese women
Purpose of review Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. Recent findings In the general gynecologic population, minima...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Perioperative considerations and anesthesia management in patients with obstructive sleep apnea undergoing ophthalmic surgery
Obstructive sleep apnea (OSA) is a disorder characterized by breathing cessation caused by obstruction of the upper airway during sleep. It is associated with multiorgan comorbidities such as obesity, hypertension, heart failure, arrhythmias, diabetes mellitus, and stroke. Patients with OSA have an increased prevalence of ophthalmic disorders such as cataract, glaucoma, central serous retinopathy (detachment of retina, macular hole), eyelid laxity, keratoconus, and nonarteritic anterior ischemic optic neuropathy; and some might require surgery.
Source: Journal of Cataract and Refractive Surgery - June 3, 2019 Category: Opthalmology Authors: Oya Y. Cok, Edwin Seet, Chandra M. Kumar, Girish P. Joshi Tags: Review/update Source Type: research

Sex Differences in Sex Hormone Profiles and Prediction of Consciousness Recovery After Severe Traumatic Brain Injury
Conclusion: These findings indicate that TBI differentially affects the levels of sex-steroid hormones in men and women patients. Plasma levels of testosterone could be a good candidate blood marker to predict recovery from unconsciousness after sTBI for male patients. Introduction Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is increasing in incidence (1). Patients with acute severe TBI (sTBI) often develop severe disorders of consciousness, i.e., coma, minimally conscious state or vegetative state. Although many patients may regain consciousness during the 1-month post-TBI p...
Source: Frontiers in Endocrinology - April 25, 2019 Category: Endocrinology Source Type: research

Atrial Transcriptional Profiles of Molecular Targets Mediating Electrophysiological Function in Aging and Pgc-1 β Deficient Murine Hearts
Conclusion: These findings limit the possible roles of gene transcriptional changes in previously reported age-dependent pro-arrhythmic electrophysiologial changes observed in Pgc-1β-/- atria to an altered Ca2+-ATPase (Atp2a2) expression. This directly parallels previously reported arrhythmic mechanism associated with p21-activated kinase type 1 deficiency. This could add to contributions from the direct physiological outcomes of mitochondrial dysfunction, whether through reactive oxygen species (ROS) production or altered Ca2+ homeostasis. Introduction Atrial arrhythmias constitute a major public health pro...
Source: Frontiers in Physiology - April 23, 2019 Category: Physiology Source Type: research

Is Aberrant Reno-Renal Reflex Control of Blood Pressure a Contributor to Chronic Intermittent Hypoxia-Induced Hypertension?
This study demonstrated unaltered vascular conductance in response to lumbar sympathetic stimulation in CIH-exposed rats. Aortic compliance was increased and estimated blood volume was unchanged in CIH-exposed rats. Increased blood pressure was related to an increase in cardiac output, which was confirmed by echocardiography (Lucking et al., 2014). It is suggested therefore that hypertension in the CIH model can be evoked by over-excitation of the cardiac arm of sympathetic nervous system (SNS), even before mechanisms of enhanced peripheral vasoconstriction and endothelial dysfunction are initiated (Naghshin et al., 2009)....
Source: Frontiers in Physiology - April 23, 2019 Category: Physiology Source Type: research

Sickle Cell Disease Subjects Have a Distinct Abnormal Autonomic Phenotype Characterized by Peripheral Vasoconstriction With Blunted Cardiac Response to Head-Up Tilt
Conclusion We have shown that SCD subjects are much more likely than non-SCD subjects to have impaired cardiac, but intact peripheral responses to orthostatic stress induced by HUT. These abnormal responses are associated with low baseline cardiac parasympathetic activity, independent of hemoglobin level. The classification of autonomic phenotypes based on HUT response may have potential use for predicting disease severity, guiding and targeting treatments/interventions to alleviate the risk of adverse outcomes in SCD. Ethics Statement All experiments were conducted at Children’s Hospital Los Angeles (CHLA). The ...
Source: Frontiers in Physiology - April 10, 2019 Category: Physiology Source Type: research

Orexin-A Prevents Lipopolysaccharide-Induced Neuroinflammation at the Level of the Intestinal Barrier
We examined a possible protective effect of OX-A against LPS-induced ROS formation and microglia activation. To mimic in vitro the connection between gut and brain and to study the putative effect on the cortical microglia, we used a co-culture of Caco-2 cells and primary cortical microglia with Caco-2 cells placed at the apical side of a transwell and primary cortical microglia at the basolateral side. All treatments used to study the apical vs. basal connection were applied to the apical compartment. We used DHR (10 μM, 20 min), a cell-permeable fluorogenic probe useful for the detection of ROS formation, to dete...
Source: Frontiers in Endocrinology - April 9, 2019 Category: Endocrinology Source Type: research

Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study
Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551. Introduction Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. In 2013 ~2.8 million TBI cases were recorded an...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Association between sleep apnea and perioperative outcomes among patients undergoing shoulder arthroscopy
ConclusionSleep apnea is associated with an increased risk of complications and resource utilization in patients undergoing shoulder arthroscopy.
Source: Canadian Journal of Anesthesia - November 9, 2018 Category: Anesthesiology Source Type: research

Association between sleep apnea and perioperative outcomes among patients undergoing shoulder arthroscopy.
CONCLUSION: Sleep apnea is associated with an increased risk of complications and resource utilization in patients undergoing shoulder arthroscopy. PMID: 30159714 [PubMed - as supplied by publisher]
Source: Canadian Journal of Anaesthesia - August 29, 2018 Category: Anesthesiology Authors: Masaracchia MM, Sites BD, Herrick MD, Liu H, Davis M Tags: Can J Anaesth Source Type: research

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