The American journal of medicine
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Climate change is leading to a rise in heat-related illnesses, vector-borne diseases, and numerous negative impacts on patients' physical and mental health outcomes. Concurrently, healthcare contributes about 4.6% of global greenhouse gas emissions. Low-value care, such as overtesting and overdiagnosis, contributes to unnecessary emissions. ⋯ Second, diagnostic quality issues, such as overtesting and overdiagnosis, contribute to climate change through unnecessary emissions and waste and should be targeted for interventions. We also highlight implications for clinical practice, research, and policy. Our findings call for efforts to engage healthcare professionals and policymakers in understanding the urgent implications for diagnosis in the context of climate change and reducing global greenhouse gas emissions to enhance both patient and planetary outcomes.
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Cellular protein kinases are involved in diverse normal cellular functions. Many types of dysregulation of protein kinases are the molecular basis for development of common cancers and neurodegenerative diseases. ⋯ Newly designed protein kinase inhibitors and related forms of therapy based on a greater understanding of molecular mechanisms have diminished the appearance of disease resistance to protein kinase inhibitors and other side effects. These advances will further promote the success of protein kinase inhibitors in treatment of common cancers, Alzheimer's disease, and other neurodegenerative conditions.
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Comparative Study
Angiotensin receptor blockers versus angiotensin converting enzyme inhibitors in acute myocardial infarction without heart failure.
Whether angiotensin II receptor blockers (ARBs) can be an alternative to angiotensin-converting enzyme inhibitors (ACEIs) in patients without heart failure (HF) after acute myocardial infarction (MI) remains controversial. The aim of this study was to compare clinical outcomes between initial ARB and ACEI therapy in patients with MI without HF. ⋯ In this nationwide cohort, there was no significant difference in the incidence of all-cause death between ARBs and ACEIs as discharge medications in patients with myocardial infarction without heart failure. Angiotensin II receptor blockers would be an alternative to ACEIs for those intolerant to ACEI therapy.
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Dementia and hepatic encephalopathy (HE) have symptom overlap and are challenging to differentiate. The presence of undiagnosed cirrhosis may lead to missed opportunities to treat HE, which was found in a veterans database. This needs validation in a non-veteran cohort. ⋯ The findings of this national cohort suggest that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia, and that hepatic encephalopathy might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
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This study investigated sex differences in acute myocarditis patients during index hospitalization. ⋯ Compared with men, women with acute myocarditis were older at the time of diagnosis, presented more often with heart failure, and had an increased frequency of severe arrhythmia.