Alameda Hospital

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Migrants often face severe trauma before and during their journey, leading to mental health challenges such as post-traumatic stress disorder and acute stress. This study explores the Flash Technique (FT) as a one-time intervention for newly arrived migrants. Twelve healthcare professionals and 11 student interns trained in FT provided interventions to 55 migrants, who showed substantial improvements in subjective units of distress scores. The findings highlight the efficacy of a low-intensity intervention in a humanitarian context, which can serve to mitigate the long-term psychological impact of trauma.

Protein kinases are key mediators of cellular signaling and control cell functions through the phosphorylation of target proteins. They have become major targets for therapeutic agents aimed at treating human diseases, particularly cancer. Protein kinase inhibitors (PKIs) have emerged at the forefront of drug development, and their investigations continue to be intense, with several candidates undergoing clinical trials and persistent endeavors to identify new chemical scaffolds. The main focus is still on developing isoform-selective compounds, which are inhibitors designed to target certain protein kinases, specifically isoforms, for more precise treatment. The identification and advancement of versatile inhibitor scaffolds that more effectively target individual kinases is essential for minimizing off-target effects and resistance. This review highlights important progress in PKI therapy, emphasizing the expansion of treatments for cancer, inflammatory diseases, and neurodegenerative diseases. Future efforts should focus on improving the specificity of inhibitors via mechanistic insights, developing combination therapies, establishing novel strategies, such as CRISPR-Cas9 integration with artificial intelligence-driven drug design, and overcoming resistance to enhance clinical treatment outcomes. Clinical case stories show the challenges and possible opportunities in this quickly evolving area.

Introdução: O conhecimento do panorama geral relacionado à prescrição de nutrição parenteral (NP) no Brasil mostra-se de suma importância, uma vez que está relacionado ao desenvolvimento de melhorias do processo assistencial prestado aos pacientes. No entanto, ainda faltam dados nacionais que reflitam as atuais práticas realizadas e evidenciem a necessidade de aprimoramento. O objetivo do presente estudo foi compreender o perfil de uso de NP no Brasil, avaliando as práticas relacionadas à prescrição, bem como estimar a incidência de complicações relacionadas à NP. Método: Trata-se de estudo prospectivo e observacional. Foi realizada uma pesquisa junto a médicos pertencentes a Equipes Multiprofissionais de Terapia Nutricional (EMTN) em todo Brasil sobre a prática de prescrição e manejo de NP. Para tal análise, cada médico respondeu a um questionário, onde informava a forma em que conduzia a terapia nutricional de seus pacientes. Os dados foram compilados para análise do estudo. Cada participante informou sua prática clínica desde a prescrição da terapia até desmame da NP ou saída hospitalar (alta/óbito). Resultados: Ao todo, 16 médicos responderam à pesquisa, totalizando 78 pacientes acompanhados por esses médicos para análise do panorama da terapia nutricional de rotina empregada nos diferentes serviços. A maior parte dos pacientes que receberam NP possuía diagnóstico cirúrgico (71,8%). 89,2% dos pacientes apresentavam risco nutricional, sendo que 41,3% dos pacientes apresentavam desnutrição na avaliação nutricional. O uso de NP exclusiva ocorreu por 35,9% dos pacientes, enquanto a nutrição mista em 64,1%. Referente às características da terapia nutricional utilizada, 46,2% dos pacientes fizeram uso de bolsa pronta para uso, enquanto 53,8% deles fizeram uso de bolsa manipulada. A incidência de complicações foi de 66,7%, sendo a disglicemia a de maior frequência. Conclusão: A NP no Brasil parece ser utilizada conforme as diretrizes nacionais e internacionais. Nota-se uma necessidade de mais estudos que discutam as principais barreiras e dificuldades relacionadas à NP em nosso país.

Magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) measures have been described as methods for quantifying spinal cord injury and predicting outcome in dogs with intervertebral disc herniation (IVDH); however, studies comparing methods for selecting regions of interest (ROIs) are currently lacking. The aims of this retrospective, methods comparison, observational study were to compare DTI measurements acquired using manual (mROI) versus semiautomated ROI (sROI) methods and to compare DTI measurements with patient outcomes. Magnetic resonance imaging scans that included DTI pulse sequences were retrieved for 65 dogs with confirmed IVDH. Regions of interest were placed at one vertebral length cranial and caudal to the region of spinal cord compression (RSCC) using the mROI and sROI methods. Scalar values based on the mROI and sROI methods were compared. There was a significant difference for all DTI measures (P<0.0001), where fractional anisotropy was higher (95% confidence interval [CI]: 0.15, 0.19) and mean diffusivity (MD; CI: -0.41, -0.35), axial diffusivity (AD; CI: -0.47, -0.36) and radial diffusivity (RD; CI: -0.36, -0.27) were lower for the mROI than for the sROI. For both the mROI and sROI, MD, AD, and RD were significantly lower (p<0.05) at the RSCC in paraplegic dogs that did not regain motor function. The findings indicated that DTI methods for quantifying SCI using open source software and ROI were feasible for use in dogs with IVDH; however, values based on sROI methods differed from values based on mROI methods. Some DTI measures based on both the mROI and sROI methods were predictive of poor patient outcome.

We sought to evaluate Free Open Access Medical Education (FOAM), defined as online educational content available free to anyone, anywhere, at any time, by classifying the most impactful FOAM content per the Social Media Index into the topics and subtopics of the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine. We then analyzed FOAM's comprehensiveness by describing over- and underrepresentation among these topics and subtopics. First, we searched for FOAM resources based on the most recent 12months of relevant content for each organ system from the top 50 Social Media Index sites. Next, we classified all 898 posts into its related topics or subtopics per the American Board of Emergency Medicine's Model of the Clinical Practice of Emergency Medicine. Finally, we analyzed how comprehensively FOAM covered each organ system and the frequency of posts that covered each organ system subtopic as well as identified the subtopics with the most frequent coverage. The search yielded 898 FOAM posts, of which cardiology and neurology were significantly overrepresented and psychobehavioral; obstetrics and gynecology; and head, ears, eyes, nose, and throat were significantly underrepresented. Among subtopics, acute coronary syndrome had the highest subtopic coverage consisting of 55.5% of all cardiology content. Other highly represented subtopics include renal colic; diabetic ketoacidosis; sepsis; and stroke with 39, 40, 40, and 71% of each of their topic's content, respectively. Although residents and programs are frequently incorporating FOAM into the educational curriculum, these materials seem to lack comprehensiveness. Educators and learners must be aware of these deficits in creating comprehensive emergency medicine curricula.