Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical ...revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 27.4%; male n = 1,649,575 72.6%). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p <0.001), a significant uptrend closed this gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p <0.001). Female gender remained an independent predictor of mortality after multivariate adjustment (odds ratio 1.40, 95% CI 1.36 to 1.43, p <0.001) across all age groups. However, in-hospital mortality decreased at a faster rate in women (3.8% to 2.7%, RR −29.1%, ptrend 0.002) than in men (2.2% to 1.6%, RR −25.7%, ptrend <0.001) from 2003 to 2012. In conclusion, CABG rates in the United States are decreasing over time, yet in-hospital mortality continues to improve. Women have worse in-hospital outcomes than men; however, the gender gap is slowly closing.
Histone methyltransferase KMT2D harbors frequent loss-of-function somatic point mutations in several tumor types, including melanoma. Here, we identify KMT2D as a potent tumor suppressor in melanoma ...through an in vivo epigenome-focused pooled RNAi screen and confirm the finding by using a genetically engineered mouse model (GEMM) based on conditional and melanocyte-specific deletion of KMT2D. KMT2D-deficient tumors show substantial reprogramming of key metabolic pathways, including glycolysis. KMT2D deficiency aberrantly upregulates glycolysis enzymes, intermediate metabolites, and glucose consumption rates. Mechanistically, KMT2D loss causes genome-wide reduction of H3K4me1-marked active enhancer chromatin states. Enhancer loss and subsequent repression of IGFBP5 activates IGF1R-AKT to increase glycolysis in KMT2D-deficient cells. Pharmacological inhibition of glycolysis and insulin growth factor (IGF) signaling reduce proliferation and tumorigenesis preferentially in KMT2D-deficient cells. We conclude that KMT2D loss promotes tumorigenesis by facilitating an increased use of the glycolysis pathway for enhanced biomass needs via enhancer reprogramming, thus presenting an opportunity for therapeutic intervention through glycolysis or IGF pathway inhibitors.
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•KMT2D is a tumor suppressor in melanoma•KMT2D rewires metabolic pathways through enhancer reprogramming•KMT2D loss impairs IGFBP5 enhancers and thereby deprives repression to glycolytic genes•KMT2D mutant melanomas are preferentially sensitive to glycolysis and IGFR inhibition
Through an in vivo epigenome-focused pooled RNAi screen, Maitituoheti et al. identify KMT2D as a tumor suppressor in melanoma. KMT2D-deficient tumors show substantial reprogramming of key metabolic pathways by reduction of H3K4me1-marked active enhancers, conferring sensitivity to glycolysis and IGFR inhibitors in melanoma with KMT2D-inactivating mutations.
Abstract Background Nepal is a low-income country in south Asia with a population of more than 27 million people. Because of late diagnosis and poor access to care, almost 90% of approximately 60 000 ...people diagnosed with cancer in Nepal annually will die within 1 year of diagnosis. Here, we describe our experience in successfully establishing a home hospice programme in Kathmandu, Nepal. Methods In 2015, Binaytara Foundation, a US-based non-profit organisation, collaborated with a Nepal-based non-profit organisation, Cancer Care Nepal, to develop a home hospice programme in Kathmandu. We interviewed 150 terminally ill patients and their family to investigate the need for a hospice programme. A project leader (a Nepali physician) was appointed. In the second phase of the programme, we trained health-care providers and implemented electronic medical records. A hospice nurse practitioner from Idaho, USA, travelled to Nepal to train 15 Nepali nurses. A motorbike was provided for the hospice nurse to travel to patients' homes. Findings The hospice programme was launched in January, 2016. By September, 2016, 65 patients had been enrolled in home hospice care. The service is provided free of charge to the patients and their family. The cost of running the hospice programme is US$17 per day. All costs, including equipment, salary, staff training, electronic medical records, fuel, and other monthly expenses have been paid for by Binaytara Foundation. Interpretation Home hospice programmes are very important in low-income countries like Nepal where most patients with cancer are diagnosed at late stages, and many patients do not have access to cancer centres. To make a home hospice project successful, several factors, such as the selection of an appropriate local partner organisation, training, and financial support are necessary and the project should respect local cultural contexts. Funding None
Quality of life of elderly is becoming even more relevant with demographic shift happening towards an ageing society. With fast changing family condition and social contexts, lives of elderly people ...in Nepal have been changing dramatically. Old age homes have sprung up to cater to the needs of the elderly from different socio-economic backgrounds. The objective of this study is to compare the quality of life of senior citizens of selected old age homes and own residence and to find the association of quality of life with selected study variables.
A comparative study was conducted among 120 senior citizens from Dhankuta, Morang and Sunsari districts of Koshi zone. Two strata were formed based on their residence, i.e., old age homes and own residence. Equal proportion of the samples were selected from both the settings. Data was collected using interview schedule through pretested semi-structured and standard World Helth Organization, quality of life - old questionnaires.
More than one fifth (23.33%) of research participants were from the age group 65-69 and 75-79 and more than half (55%) of them were female. More than half (58.33%) of the research participants residing in their own residence had high quality of life level, while among those residing in the old age homes, only about 40% had high quality of life level. Quality of life level was found to be significantly associated with sex and educational status of the research participants.
Quality of life was found to be better among the people residing in their own residence as compared to those residing in old age homes.
Abstract Depression has been associated with adverse outcomes after acute coronary syndrome (ACS), including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and ...in-hospital treatment of STEMI for patients with comorbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of STEMI patients (weighted n=3,057,998) in the National Inpatient Sample from 2003-2012. We examined trends in STEMI incidence and percutaneous coronary intervention (PCI) for patients with and without depression. We used multivariate logistic regression to assess observed differences as well as to explore trends in in-hospital mortality. Depression was present in 153,180 (5%) of the sample. Patients with depression were more likely to be female (55% vs 37%), of white race (86% vs 78%), and had lower crude mortality (12.0% vs 14.2%; p<0.001 for all). Over time, STEMI incidence declined 52% in patients without depression (p for trend <0.001) but remained stable in those with depression (p for trend 0.74). Although the use of PCI increased in all subgroups over the study duration (p for trend <0.001), depression was associated with lower adjusted odds of PCI (odds ratio 0.90, 95% confidence interval 0.89-0.92, p<0.001). In conclusion, in contrast to the wider population, the incidence of STEMI is not declining in patients with comorbid depression. Patients with STEMI and comorbid depression are less likely to receive revascularization therapy with PCI. These concerning differences warrant further attention.
Background: Differentiation of idiopathic right ventricular (RV) tachycardia from ventricular tachycardias (VTs) due to arrhythmogenic RV cardiomyopathy (ARVC), myocarditis, or sarcoidosis can be ...challenging in patients without apparent structural heart disease.
Introduction: Nursing care is necessary for every client seeking any type of healthcare such as health promotion, diagnosis, treatment and recovery. Despite these facts, nurses are given less ...importance and their works are even unrecognized. Objective: The objective of this study was to explore nursing care provided to inpatients of medical ward at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Methodology: Hospital based cross-sectional study was carried out in medical ward of B. P. Koirala Institute of Health Sciences, Dharan from Feb 2017 to Oct 2018. Data were retrieved from inpatient admission record book of medical ward of previous 15 months from the initiation of this research work. Admission record book was reviewed and checked for completeness of the record. A total of 290 patients having complete records were enrolled. Collected data were entered in Microsoft excel and analysed by SPSS software. Results: More than half patients (52.8%) were male and 44.8% belonged to Janajati ethnicity. The major age group was 15-25 years (17.9%) with mean and standard deviation of 49.4±20.6. About 28.6 % of the patients were admitted due to cardiovascular related problems and poisoning (13.1%). Most of the patients (67%) were admitted from emergency. Median duration of stay was 4 days. Every 8 out of 10 patients were recovered and discharged. General nursing care provided were maintenance of personal hygiene (91.03%), cannula site care (49.7%), providing psychological support (41%), ambulation (8.3%), back care (7.6%), catheter care(6.9%), passive exercise (2.4%), chest physiotherapy(3.7%), sponge bath(9.3%). Specific care provided were propped-up positioning (36.2%), 2 hourly position change (23.4%), random blood sugar monitoring (12.4%), SpO2monitoring (8.9%), watch for oxygen toxicity (9.3%), weight monitoring (3.1%) and pre CAG (coronary angiography) care(2.1%). Conclusion: Maintenance of personal hygiene, cannula site care, psychological support, two hourly positioning and oral care were the common practices performed.BIBECHANA 16 (2019) 204-212
Most documented studies have focused on mental health status of health care workers during the pandemic but there are very few studies, focusing on mitigation of mental health problems among nurses.
...To study psychosocial responses to COVID-19 and the effectiveness of intervention among nurses.
A mixed-method study was conducted, including 278 nurses from two COVID-19 hospitals of the province by purposive sampling. Depression, anxiety and stress and a composite measure of personal financial burden scales for quantitative; and interview guide for qualitative data were used. A psychosocial strengthening session was introduced and the effectiveness of the program was assessed after 4-5 weeks of intervention.
Mild, moderate and severe depression was found among 13.7%, 9.4% and 1.1% of the participants correspondingly. Mild, moderate, severe and extremely severe anxiety was found among 21.2%, 8.6%, 3.2% and 2.2% of the participants respectively. Stress was mild among 9% and moderate in 1.4% of the participants. Lack of PPE and fear of transmitting infection were found as frequent causes of problems. Mean scores of depression, anxiety and stress were significantly decreased after the psychosocial strengthening program.
Depression, anxiety and stress are common issues of nurses. Common causes of problems were lack of resources, fear of being infected and fear of transmitting to family members. The psychosocial strengthening program was effective in reducing the problems.
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of ...initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
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