Predictive value of SYNTAX score II for clinical outcomes in cardiogenic shock underwent primary percutaneous coronary intervention; a pilot study

SYNTAX Score II (SSII) connects clinical variables with coronary anatomy. We investigated the prognostic value of SSII in patients with ST segment elevated myocardial infarction (STEMI) complicated with cardiogenic shock treated with primary percutaneous coronary intervention (PPCI). In this retrospective analysis, we evaluated the in-hospital prognostic impact of SSII on 492 patients with STEMI complicated with cardiogenic shock treated with PPCI. Patients were stratified by tertiles of SSII, in-hospital clinical outcomes were compared between those groups. In-hospital univariate analysis revealed higher rates of in-hospital death for patients with SSII in tertile 3, as compared to patients with SSII in tertile 1 (OR 17.4, 95% CI 10.0–30.2, p?<?0.001). After adjustment for confounding baseline variables, SSII in tertile 3 was associated with 6.2-fold hazard of in-hospital death (OR 6.2, 95% CI 2.6–14.1, p?<?0.001). SSII in patients with STEMI complicated with cardiogenic shock treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggests SSII to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with STEMI complicated with cardiogenic shock treated with PPCI.     

A US Population Health Survey on the Impact of COVID-19 Using the EQ-5D-5L

BackgroundThe COVID-19 pandemic has resulted in negative impacts on the economy, population health, and health-related quality-of-life (HRQoL).ObjectiveTo assess the impact of COVID-19 on US population HRQoL using the EQ-5D-5L.DesignWe surveyed respondents on physical and mental health, demographics, socioeconomics, brief medical history, current COVID-19 status, sleep, dietary, financial, and spending changes. Results were compared to online and face-to-face US population norms. Predictors of EQ-5D-5L utility were analyzed using both standard and post-lasso OLS regressions. Robustness of regression coefficients against unmeasured confounding was analyzed using the E-Value sensitivity analysis.SubjectsAmazon MTurk workers (n=2776) in the USA.Main MeasuresEQ-5D-5L utility and VAS scores by age group.Key ResultsWe received n=2746 responses. Subjects 18–24 years reported lower mean (SD) health utility (0.752 (0.281)) compared with both online (0.844 (0.184), p=0.001) and face-to-face norms (0.919 (0.127), p<0.001). Among ages 25–34, utility was worse compared to face-to-face norms only (0.825 (0.235) vs. 0.911 (0.111), p<0.001). For ages 35–64, utility was better during pandemic compared to online norms (0.845 (0.195) vs. 0.794 (0.247), p<0.001). At age 65+, utility values (0.827 (0.213)) were similar across all samples. VAS scores were worse for all age groups (p<0.005) except ages 45–54. Increasing age and income were correlated with increased utility, while being Asian, American Indian or Alaska Native, Hispanic, married, living alone, having history of chronic illness or self-reported depression, experiencing COVID-19-like symptoms, having a family member diagnosed with COVID-19, fear of COVID-19, being underweight, and living in California were associated with worse utility scores. Results were robust to unmeasured confounding.ConclusionsHRQoL decreased during the pandemic compared to US population norms, especially for ages 18–24. The mental health impact of COVID-19 is significant and falls primarily on younger adults whose health outcomes may have been overlooked based on policy initiatives to date.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06674-z.     

An unusual pattern of testosterone metabolism in tissue associated with a keratin-filled cutaneous cyst.

Testosterone metabolism was studied in tissues associated with a keratin-filled cutaneous cyst. Instead of the 5alpha-reduced metabolites usually associated with skin steroid metabolism, considerable amounts of 5beta-reduced steroids were found. These included 5beta-androstane-3,17-dione, 17beta-hydroxy-5beta-androstan-3-one, and 5beta-androstane-3beta,17beta-diol. This change in metabolic pattern is discussed.     

The treatment of bleeding in hemophilic patients with inhibitors with recombinant factor VIIa

Recombinant factor VIIa (rFVIIa) has proven efficacy in the treatment of patients with alloantibodies and autoantibodies to factors VIII and IX. More than 80% of over 2,000 reported bleeding episodes treated with rFVIIa have been controlled in a variety of clinical circumstances. Its theoretical lack of activation of the coagulation system prompted many clinicians to undertake elective surgical procedures using rFVIIa in addition to on-demand treatment of minor bleeding episodes. Hemostatic efficacy has been good for most of these surgical procedures, without serious adverse events. rFVIIa is considered a useful, safe, and effective treatment for bleeding in patients with anti-factor VIII (FVIII) and anti-factor IX (FIX) inhibitors. However, the optimal dose for various clinical situations has yet to be established and requires further investigation. Laboratory monitoring of treatment using plasma FVIIa measurements should be better standardized. Despite the relatively high cost of this new drug, rFVIIa represents a major therapeutic advance in the treatment of hemophilic patients with inhibitors.     

Androgen metabolism in skin and skeletal muscle of the rainbow trout (Salmo gairdnerii) and in accessory sexual organs of the spur dogfish (Squalus acanthias).

The in vitro metabolism of testosterone, 4-androstene-3,17-dione (androstenedione) and dehydroepiandrosterone by skin and muscle from the rainbow trout (Salmo gairdnerii), and by skin and accessory sexual tissues from the spur dogfish (Squalus acanthias) was studied. In trout skin, testosterone was transformed mainly into 5α-dihydrotestosterone together with smaller amounts of 5α-androstane-3α, 17β-diol, androstenedione, 5α-androstane-3,17-dione and androsterone. Androstenedione was transformed mainly into 5α-androstane-3,17-dione with smaller amounts of testosterone, 5α-dihydrotestosterone, androsterone and 5α-androstane-3α,17β-diol. Dehydroepiandrosterone was transformed to 5-androstene-3β,17β-diol with trace quantities of androstenedione and 5α-androstane-3,17-dione. Unidentified polar nonconjugated metabolites and traces of steroid glucuronides were formed from the three substrates. The patterns of steroid metabolism were similar in dorsal and ventral skin, and in dorsal skin from male and female, adult and immature fish. Most of the 5α-reductase activity in the skin was in the dermis, only a small fraction of the total activity being in the epidermis. The trout muscle converted testosterone into 5α-dihydrotestosterone but in much lower yields than did skin.The skin, clasper, sperm sac and vas deferens of an adult male spur dogfish converted testosterone to 5α-dihydrotestosterone and androstenedione, though in much lower yields than did trout skin. Androstenedione was converted into testosterone, 5α-androstane-3, 17-dione and androsterone, while dehydroepiandrosterone was converted into 5-androstene-3β,17β-diol. No metabolism of testosterone was detected in the skeletal muscle of the dogfish.