Exploring increased cardiovascular research in central Virginia issues improving care for patients
Death Risk After Acute Kidney Injury Varies By Discharge Blood Pressure
Death risk after an acute kidney injury (AKI) hospitalization varies by discharge blood pressure category and over time, a new study finds.
Investigators studied outcomes among 80,960 admissions with AKI in Veteran Healthcare Association (VHA) hospitals. Most of the cohort was male (96.3%), and 70.7% were aged 65 years or older. Patients with severe or end-stage liver disease, stage 4 or 5 chronic kidney disease, end-stage kidney disease, or metastatic cancer were excluded.
Within 1 year of AKI, 12,876 patients (15.9%) died. Patients with a systolic blood pressure (SBP) value of 130-139 mm Hg had the most favorable risks for all-cause mortality and readmission, Benjamin R. Griffin, MD, of University of Iowa Hospitals and Clinics in Iowa City, and colleagues reported in JAMA Network Open. Compared with patients with SBP of 160 mm Hg or greater (reference), all-cause mortality risk for patients with SBP of 130-139 mm Hg was a significant 20% higher at 60 days but 42% lower at 365 days. For patients with SBP of 120-129 mm Hg, death risk was a significant 36% higher at 60 days but similar at 365 days compared with the reference category. Patients with an SBP less than 120 mm Hg had a significant 2.2-fold increased risk for all-cause mortality at 60 days and 1.8-fold higher at 365 days compared with the reference. Those with discharge SBP of 140 to 159 mm Hg had similar risks to those with a SBP of 160 mm Hg or greater.
The risk for readmission within 60 days was significantly increased 28%, 15%, 0%, 13%, and 14% at an SBP less than 120, 120-129, 130-139, 140-149, and 150-159 mm Hg, respectively, compared with the reference value of 160 mm Hg or more. The lowest SBP category continued to be at elevated risk for readmission up to 120 days.
Use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) was significantly associated with 16%, 14%, and 17% decreased risk of death at 60 days among patients with SBP of less than 120, 120-129, and 130-139 mm Hg, respectively, compared with the reference. The risk of readmission with 60 days did not change with use of ACE inhibitors or ARBs, however, at any SBP category from less than 120 to more than 160 mm Hg.
"While caution must be exercised when applying observational studies to clinical practice, our results would support a strategy of allowing for a 3-month recovery period prior to escalating blood pressure regimens to target a blood pressure of 130 to 139 mm Hg in those who experienced AKI during a hospital admission," according to Dr Griffin's team.
The cohort had high rates of diabetes (20.0%), congestive heart failure (28.1%), and chronic lung disease (34.2%).
Stage 1, 2, and 3 AKI affected 78.5%, 9.5%, and 11.6% of patients, respectively. A total of 936 patients (1.2%) had AKI requiring kidney replacement therapy. More than half of patients (55.2%) had kidney recovery at discharge, and 79.2% at 90 days.
Gaurav Singal And Anupam B. Jena: It's Not Just Hype. AI Could Revolutionize Diagnosis In Medicine.
The history of medical diagnosis is a march through painstaking observation. Ancient Egyptian physicians first diagnosed urinary tract infections by observing patterns in patients' urine. To diagnose diseases of the heart and lungs, medieval doctors added core elements of the physical examination: pulse, palpation and percussion. The 20th century saw the addition of laboratory studies, and the 21st century of sophisticated imaging and genetics.
Despite advances, however, diagnosis has largely remained a human endeavor, with doctors relying on so-called illness scripts — clusters of signs, symptoms and diagnostic findings that are hallmarks of a disease. Medical students spend years memorizing such scripts, training themselves to, for example, identify the sub-millimeter variations in electrocardiogram wave measurements that might alert them to a heart attack.
But human beings, of course, err. Sometimes, misdiagnosis occurs because a doctor overlooks something — when the patterns of illness fit the script, but the script is misread. This happens in an estimated 15% to 20% of medical encounters. Other times, misdiagnosis occurs because the illness has features that do not match known patterns — they do not fit the script, such as when a heart attack occurs without telltale symptoms or EKG findings.
Artificial intelligence can help solve these two fundamental problems — if it's given enough financial support and deployed correctly.
First, AI is less susceptible to common factors that lead doctors to make diagnostic errors: fatigue, lack of time and cognitive bandwidth when treating many patients, gaps of knowledge and reliance on mental shortcuts. Even when illnesses conform to scripts, computers will sometimes be better than humans at identifying details buried within voluminous health care data.
Using AI to improve the accuracy and timeliness with which doctors recognize illness can mean the difference between life and death. Ischemic stroke, for example, is a life-threatening emergency where a blocked artery impedes blood flow to the brain. Brain imaging clinches the diagnosis, but that imaging must be performed and interpreted by a radiologist quickly and accurately. Studies show that AI, through superhuman pattern matching abilities, can identify strokes seconds after imaging is performed — tens of minutes sooner than by often-busy radiologists. Similar capabilities have been demonstrated in diagnosing sepsis, pneumonia, blood clot in the lungs ( pulmonary embolism), acute kidney injury and other conditions.
Second, computers can be useful for illnesses for which we haven't developed the right scripts. AI can, in fact, diagnose disease using new patterns too subtle for humans to identify. Consider, for example, hypertrophic cardiomyopathy, a rare genetic condition in which the heart's muscle has grown more than it should, leading to eventual heart failure and sometimes death. Experts estimate that only 20% of those affected are diagnosed, a process that requires consultation with a cardiologist, a heart ultrasound and often genetic testing. What, then, of the remaining 80%?
Researchers across the country, including at the Mayo Clinic and UC San Francisco, have demonstrated that AI can detect complex, previously unrecognized patterns to identify patients likely to have hypertrophic cardiomyopathy, meaning AI-driven algorithms will be able to screen for the condition in routine EKGs.
AI was able to recognize these patterns after examining the EKGs of many people with and without the disease. The rapid growth in health care data — including detailed electronic health records, imaging, genomic data, biometrics and behavioral data — combined with advancements in artificial intelligence technology has created a major opportunity. Because of its unique ability to identify patterns from the data, AI has helped radiologists to find hidden cancers, pathologists to characterize liver fibrosis and ophthalmologists to detect retinal disease.
One challenge is that AI is expensive, requiring large-scale data to train computer algorithms and the technology to do so. As these resources become more ubiquitous, that can make the associated intellectual property difficult to protect, discouraging private investment in these products. More generally, diagnostics have long been considered unattractive investments. Unlike their therapeutic counterparts, which see around $300 billion in research and development investment a year, diagnostics receive a modest $10 billion in private funding.
Then there's the question of who pays for the use of AI-based tools in medicine specifically. Some applications, such as detecting strokes, save insurers money (by preventing costly ICU stays and subsequent rehabilitation). These technologies tend to get reimbursed more quickly. But other AI solutions, such as detecting hypertrophic cardiomyopathy, may lead to increased spending on costly downstream therapies to treat newly identified chronic illness. Although the use of AI may improve quality of care and long-term outcomes in such cases, without financial incentives for insurers, reimbursement and thus adoption may be slow.
Life sciences companies have on rare occasion agreed to subsidize development or reimbursement of AI-based diagnostics. This will help bridge the gap, but the federal government may need to play a greater role. Federal support for covid diagnostics during the pandemic drove rapid development of critical tests, and the cancer moonshot project has helped drive R&D in screening and new treatments.
It is usually tough to marshal funding at the scale needed for new medical frontiers. But the National Academies of Medicine has estimated that tens of billions of dollars and countless lives could be saved from improving diagnosis in medicine.
Artificial intelligence offers a path toward that. It should complement, rather than replace, the human expertise that already saves so many lives. The future of medical diagnosis doesn't mean handing over the keys to AI but, rather, making use of what it can do that we can't. This could be a special moment for diagnosis, if we invest enough and do it right.
From Long Covid To CFS – 7 Crippling Post-viral Illnesses That Can Strike As Violet Affleck Shares Health Struggles
JUST a few years ago, the sight of someone wearing a face mask was commonplace.
But a mask-wearing Violet Affleck made headlines this week after revealing she'd suffered from a "post viral condition" as she blasted current mask mandates at a Los Angeles city board meeting.
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Violet Affleck ,18, revealed health condition and demanded mask mandates at LA hearingCredit: The Mega Agency5
The teen, with mum Jennifer Garner, has often been seen out and about with masksCredit: Getty5
Also daughter to Ben Affleck, it was often assumed she was seeking privacyCredit: Splash5
Violet revealed she'd suffered a post-viral condition in 2019Credit: GettyThe 18-year-old is the eldest daughter of former Hollywood power couple Ben Affleck and Jennifer Garner and attended the meeting to address the lack of mask wearing in the city's hospitals.
It's not the first time Violet has been spotted out in public sporting an N95 mask.
She's been snapped wearing one at a party with her dad and stepmum J-Lo, as well as running errands with her family.
Fans might have assumed the teen was trying to maintain some form of privacy, but Violet revealed she'd adopted mask-wearing after suffering a devastating health condition a few years ago.
"I contracted a post-viral condition in 2019," Violet said in a passionate speech delivered at the LA city board meeting on Tuesday.
"I'm OK now, but I saw first-hand that medicine does not always have answers to the consequences of even minor viruses.
"The Covid-19 pandemic has thrown that into sharper relief."
Violet didn't give any additional details about her condition, but she called on officials to do more to help people with long Covid.
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"They do not keep us safer, they make vulnerable members of our community less safe and make everyone less able to participate in Los Angeles together."
Are we in a summer Covid wave?According to the Mayo Clinic, a post-viral condition occurs following a viral infection, and is characterised by fatigue, lethargy, memory loss, inability to focus, and exhaustion that can last for months following the initial infection.
Nowadays, most of us will have at least a vague idea of what long Covid is.
Leaving a trail of people grappling with debilitating symptoms even after they'd supposedly recovered from the infection, it's characterised by extreme tiredness, shortness of breath, brain fog, heart palpitations and joint pain.
But Covid is just one of many illnesses that can cause severe and widespread damage to the body, leaving people with lingering symptoms.
"All manner of infectious agents, including bacteria, viruses, and parasites, has been implicated in post-acute infection syndromes pathogenesis," researchers from Yale and Columbia University wrote in a 2022 study published to the journal Nature Medicine.
"Unfortunately, the association between acute infectious diseases and unexplained chronic disability remains understudied, which leads to poor recognition of these conditions in clinical practice."
From chronic fatigue syndrome to post-sepsis syndrome, here are the post-viral and post-acute infection illnesses to know.
1. Chronic fatigue syndromeMyalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS, is a long-term neurological disease that can affect different parts of the body with varying degrees of severity.
It's estimated to affect 250,000 people in the UK, according to Action for ME.
The most common symptom is extreme tiredness that can make it difficult to do normal activities like taking a shower, cooking a meal or going to work or school, the NHS says.
Sleep issues - like insomnia or sleeping too much - are also common, as well as problems with thinking and memory.
Some people with ME/CFS may have pain in different parts of their body or flu-like symptoms, such as high temperature, headache and aching joints or muscles.
Symptoms tend to get worse after physical or mental activity and it can sometimes take sufferers weeks to get better.
The cause or causes of ME/CFS aren't well understood.
It can be triggered by certain infections, including mononucleosis, herpes or a Covid-19 infection.
In fact, those who have long Covid often meet the definition of ME/CFS, according to Johns Hopkins Medicine.
Non-viral triggers can include salmonella, tuberculosis and Lyme disease, Action for ME states.
But often the exact cause of ME/CFS isn't always apparent.
2. Long CovidUnsurprisingly, long Covid has been the subject of extensive study over the past few years.
It's a chronic condition occurring after a Covid-19 infection. Most people tend to feel better within a few days or weeks of getting Covid but for some, symptoms can last a lot longer.
According to the NHS, the most common symptoms of long Covid include:
But others may also experience loss of smell, chest pain, insomnia, depression and anxiety, the feeling of pins and needles, as well as tinnitus and earaches and rashes - this is just to name a few symptoms.
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It's been estimated that up to two million Brits may have long Covid.
The chances of having long-term symptoms doesn't seem to be linked to how ill you were when you were first infected.
Studies also suggest that people who've had Covid are at increased risk of serious health complications months and years later - including heart and lung issues, kidney problems, and liver injury.
3. 'Long colds' and 'long flu'Scientists last year revealed the existence of 'long colds' and 'long flu'.
Experts at Queen Mary University of London said lingering symptoms from the common cold are actually a fairly common occurrence, with people complaining of coughing, stomach pain and diarrhoea for weeks after their initial illness.
The same goes for 'long flu' - researchers from Washington University School of Medicine in St. Louis followed patients for 18 months after being admitted to hospital with the common illness.
The study - published in the Lancet Infectious Diseases - found that flu patients were at risk experiencing lingering disease, reporting symptoms like persistent shortness of breath and a cough.
In fact, it's been suggested that almost any viral infection can leave people feeling tired and weak for weeks and months after they've supposedly recovered from it.
Medical News Today referred to these ongoing symptoms triggered by viruses as "post viral syndrome", saying it could be caused by:
Guillain-Barré syndrome (GBS) is a rare disorder where the body's immune system damages the nerves, resulting in muscle weakness and sometimes paralysis.
Symptoms tend to start with numbness, weakness, pain and pins and needles spreading from the hands and feet up the limbs, the NHS says.
It's treatable and most people will eventually make a full recovery, but it can occasionally be life-threatening and one in five people are left with long-term problems, such as difficulty walking, balance problems and extreme tiredness.
How to manage post-viral fatigue
POST-viral fatigue affects people of all ages.
How long someone experiences fatigue for and the severity of their symptoms doesn't always reflect the severity of the initial infection or their previous fitness levels.
Some people can be very unwell at the start of the illness but recover relatively quickly, whilst other people may only have a mild viral illness but go on to have debilitating fatigue for a long time afterwards.
The British Association of Clinicians in ME/CFS had some tips for dealing with fatigue after an illness.
Source: NHS North Bristol
While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria, according to the Centers for Disease Control and Prevention (CDC).
"About two-thirds of people with GBS were sick with diarrhoea or respiratory illness days or weeks before developing symptoms," it added.
One of the most common risk factors is infection with the bacteria Campylobacter jejuni, which causes gastroenteritis.
People can also develop the rare condition after having the flu or being infected with the Epstein-Barr virus, which causes glandular fever - also known as kissing disease.
5. Post-sepsis syndromeSepsis is a life-threatening condition, caused by the body overreacting to an infection and causing organs to shut down - so recovery can often be challenging.
But around 40 per cent of people who develop sepsis could go on to suffer physical, cognitive, and psychological after effects, according to The UK Sepsis Trust.
Common physical symptoms brought on by post-sepsis syndrome include:
People can also be saddled with psychological symptoms such as anxiety, depression, flashbacks and nightmares, as well as memory loss and mood swings.
6. Post-dengue fatigue syndromeDengue is a mosquito-borne viral infection that's spread from mosquitoes to people.
It's most common in tropical and subtropical regions, though critters carrying the virus have recently been spotted across Europe.
Most people who get bitten by an infected mozzie won't have any symptoms.
But for those who do, the most common symptoms are high fever, headache, body aches, nausea, and rash.
Some go on to develop severe dengue and need care in a hospital, the World Health Organization said.
According to Yale and Columbia scientists, post-dengue fatigue syndrome can sometimes follow an dengue infection.
Studies show people who've recovered from dengue still suffering with debilitating fatigue months afterwards.
The risk is also present following a chikungunya infection, another mosquito-borne virus that causes fever and joint pain, as well as a West Nile virus infection.
7. Post-giardiasis symptomsFinally, giardiasis - a tummy bug triggered by a tiny parasite - might also cause lingering symptoms after recovery, Yale and Columbia scientists suggested.
Read more on the Irish Sun"Prolonged, debilitating, chronic symptoms have long been reported in a subset of patients after common and typically non-serious infections [such as] an outbreak of Giardia lamblia, an intestinal parasite that usually causes acute intestinal illness," they said.
"In fact, several studies identified the association of this outbreak of giardiasis with chronic fatigue, irritable bowel syndrome (IBS) and fibromyalgia persisting for many years."
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